MEDICARE: KHALIFAH HOLDINGS INCORPORATED

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1457985962
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KHALIFAH HOLDINGS INCORPORATED

Provider Business Mailing Address
First Line	:	2616 LOSEE RD STE 11
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-4128
Country	:	US
Telephone Number	:	775-400-3114
Fax Number	:	888-959-8990

Provider Business Practice Location Address
First Line	:	2616 LOSEE RD STE 11
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-4128
Country	:	US
Telephone Number	:	775-400-3114
Fax Number	:	888-959-8990

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ALI JAI AL-ZAKAR FAISON
Credential	:
Telephone Number	:	775-400-3114

Provider Enumeration Date	:	02/24/2020
Last Update Date	:	02/24/2020

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