MEDICARE: TOTAL CARE AND CONSULTING 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	251S00000X	Community/Behavioral Health Agency	NV20111487272	NV

General Provider Information

NPI Number	:	1346528957
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOTAL CARE AND CONSULTING LLC

Provider Business Mailing Address
First Line	:	1408 GENTLE BROOK ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-2029
Country	:	US
Telephone Number	:	702-336-6126
Fax Number	:	928-832-6125

Provider Business Practice Location Address
First Line	:	1408 GENTLE BROOK ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-2029
Country	:	US
Telephone Number	:	702-336-6126
Fax Number	:	928-832-6125

Authorized Official
Title or Position	:	PRINCIPLE
Name	:	MR. THEODIS THROWER JR.
Credential	:
Telephone Number	:	702-336-6126

Provider Enumeration Date	:	07/31/2011
Last Update Date	:	07/31/2011

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