MEDICARE: KRAMER - U, 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	101YA0400X	Addiction (Substance Use Disorder) Counselor	NV20171758514	NV

General Provider Information

NPI Number	:	1356840631
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KRAMER - U, LLC

Provider Business Mailing Address
First Line	:	845 PERUMEAN LN
Second Line	:
City	:	YERINGTON
State	:	NV
Zip	:	89447-2361
Country	:	US
Telephone Number	:	775-722-5621
Fax Number	:	775-463-4032

Provider Business Practice Location Address
First Line	:	701 E BRIDGER AVE STE 110
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-5557
Country	:	US
Telephone Number	:	702-580-4196
Fax Number	:	702-924-4423

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. DEBBIE K RIFE
Credential	:
Telephone Number	:	775-722-5621

Provider Enumeration Date	:	02/01/2018
Last Update Date	:	02/23/2018

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