MEDICARE: MARTHA'S HOUSE SENIOR LIVING, L.L.C.

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	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1366372757
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARTHA'S HOUSE SENIOR LIVING, L.L.C.

Provider Business Mailing Address
First Line	:	1516 WINWOOD ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-1575
Country	:	US
Telephone Number	:	702-217-4616
Fax Number	:

Provider Business Practice Location Address
First Line	:	1516 WINWOOD ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-1575
Country	:	US
Telephone Number	:	702-217-4616
Fax Number	:

Authorized Official
Title or Position	:	MANAGING OWNER
Name	:	MR. JESSEREY TUGAS
Credential	:
Telephone Number	:	702-217-4616

Provider Enumeration Date	:	05/19/2026
Last Update Date	:	05/19/2026

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