MEDICARE: ST JEAN SENIOR CARE

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	311500000X	Alzheimer Center (Dementia Center)	5936AGZ-2	NV

General Provider Information

NPI Number	:	1518209329
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST JEAN SENIOR CARE

Provider Business Mailing Address
First Line	:	6924 ACOMA CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-5305
Country	:	US
Telephone Number	:	702-489-9297
Fax Number	:

Provider Business Practice Location Address
First Line	:	6924 ACOMA CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-5305
Country	:	US
Telephone Number	:	702-489-9297
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ROBERT ILAGAN ST JEAN
Credential	:
Telephone Number	:	702-489-9297

Provider Enumeration Date	:	03/19/2013
Last Update Date	:	03/19/2013

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