MEDICARE: WILLIE DARNELL MANOR

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	225400000X	Rehabilitation Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346550498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIE DARNELL MANOR

Provider Business Mailing Address
First Line	:	513 E LA MADRE WAY
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89081-3048
Country	:	US
Telephone Number	:	702-596-6940
Fax Number	:	702-989-4669

Provider Business Practice Location Address
First Line	:	513 E LA MADRE WAY
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89081-3048
Country	:	US
Telephone Number	:	702-596-6940
Fax Number	:	702-989-4669

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2010
Last Update Date	:	10/07/2010

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Directions to “ WILLIE DARNELL MANOR ” Practice Location

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