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NPI Code Detail

MEDICARE: CHARLLIYAH EBERHARDT

MEDICARE: CHARLLIYAH EBERHARDT
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
13747P1801XPersonal Care Attendant

General Provider Information

NPI Number : 1487286530
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLLIYAH EBERHARDT
Provider Business Mailing Address
First Line : 8101 W FLAMINGO RD UNIT 2054
Second Line :
City : LAS VEGAS
State : NV
Zip : 89147-7417
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 11500 S EASTERN AVE STE 150
Second Line :
City : HENDERSON
State : NV
Zip : 89052-5576
Country : US
Telephone Number : 702-848-5564
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2020
Last Update Date : 02/06/2020

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Directions to “ CHARLLIYAH EBERHARDT ” Practice Location

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