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NPI Code Detail

MEDICARE: COMMUNITY BENEFITS CONSORTIUM, INC.

MEDICARE: COMMUNITY BENEFITS CONSORTIUM, INC.
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
1251E00000XHome Health Agency6079PCS-2NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
142OTHERNVHOME HEALTH
246OTHERRESPITE CARE

General Provider Information

NPI Number : 1497043327
Entity Type Code : Organization
Provider Name (Legal Business Name) : COMMUNITY BENEFITS CONSORTIUM, INC.
Provider Business Mailing Address
First Line : 1771 E FLAMINGO RD
Second Line : SUITE B118
City : LAS VEGAS
State : NV
Zip : 89119-5155
Country : US
Telephone Number : 702-413-7791
Fax Number : 702-413-7792
Provider Business Practice Location Address
First Line : 1771 E FLAMINGO RD
Second Line : SUITE B118
City : LAS VEGAS
State : NV
Zip : 89119-5155
Country : US
Telephone Number : 702-413-7791
Fax Number : 702-413-7792
Authorized Official
Title or Position : CEO/ADMINISTRATOR
Name : MS. OPHELIA SIMMONS-URQUHART
Credential :
Telephone Number : 702-413-7791
Provider Enumeration Date : 07/12/2011
Last Update Date : 07/12/2011

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Directions to “COMMUNITY BENEFITS CONSORTIUM, INC. ” Practice Location

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