MEDICARE: SANSOM SOLUTIONS 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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1356858583
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANSOM SOLUTIONS LLC

Provider Business Mailing Address
First Line	:	7143 CABIN FEVER ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-3147
Country	:	US
Telephone Number	:	702-340-4813
Fax Number	:

Provider Business Practice Location Address
First Line	:	7143 CABIN FEVER ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-3147
Country	:	US
Telephone Number	:	702-340-4813
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHIRLEY PAGE
Credential	:
Telephone Number	:	702-340-4813

Provider Enumeration Date	:	01/09/2018
Last Update Date	:	01/09/2018

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