MEDICARE: PALMS CARE HOME,LLC

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	311500000X	Alzheimer Center (Dementia Center)

General Provider Information

NPI Number	:	1295228922
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALMS CARE HOME,LLC

Provider Business Mailing Address
First Line	:	11745 STONEWALL SPRINGS AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89138-1577
Country	:	US
Telephone Number	:	702-994-0857
Fax Number	:

Provider Business Practice Location Address
First Line	:	8351 W HAMMER LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-4606
Country	:	US
Telephone Number	:	702-994-0857
Fax Number	:	702-476-8933

Authorized Official
Title or Position	:	OWNER
Name	:	LOURDES MANGUINO
Credential	:
Telephone Number	:	702-994-0857

Provider Enumeration Date	:	06/07/2018
Last Update Date	:	11/15/2018

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