MEDICARE: SACHELE SENIOR GUEST HOME II

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	:	1376164301
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SACHELE SENIOR GUEST HOME II

Provider Business Mailing Address
First Line	:	3397 EL CAMINO REAL
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-3424
Country	:	US
Telephone Number	:	702-493-2727
Fax Number	:

Provider Business Practice Location Address
First Line	:	3397 EL CAMINO REAL
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-3424
Country	:	US
Telephone Number	:	24-932-7277
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ROWENA PACE
Credential	:
Telephone Number	:	702-493-2727

Provider Enumeration Date	:	04/30/2020
Last Update Date	:	12/15/2023

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