MEDICARE: GRACE CARE CENTER

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	:	1497007819
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACE CARE CENTER

Provider Business Mailing Address
First Line	:	3260 FOUNTAIN FALLS WAY UNIT 2128
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-2236
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3260 FOUNTAIN FALLS WAY UNIT 2128
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-2236
Country	:	US
Telephone Number	:	702-501-7607
Fax Number	:

Authorized Official
Title or Position	:	BASIC SKILLS TRAINER
Name	:	JOHNNY SPAIGHT
Credential	:
Telephone Number	:	702-501-7607

Provider Enumeration Date	:	10/09/2012
Last Update Date	:	10/09/2012

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Directions to “GRACE CARE CENTER ” Practice Location

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