MEDICARE: ACCESSIBLE SPACE INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0400X	Rehabilitation Clinic/Center
2	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1285352211
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACCESSIBLE SPACE INC.

Provider Business Mailing Address
First Line	:	6375 W CHARLESTON BLVD BLDG L
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-1139
Country	:	US
Telephone Number	:	702-259-1903
Fax Number	:	702-259-1907

Provider Business Practice Location Address
First Line	:	3253 HASTINGS AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-4431
Country	:	US
Telephone Number	:	702-259-1903
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	JERRY KAPPELER
Credential	:
Telephone Number	:	702-259-1903

Provider Enumeration Date	:	08/16/2022
Last Update Date	:	08/16/2022

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Directions to “ACCESSIBLE SPACE INC. ” Practice Location

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