MEDICARE: NEVADA MEMORY CARE & ASSISTED LIVING CENTERS LLC

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	310400000X	Assisted Living Facility
2	311500000X	Alzheimer Center (Dementia Center)

General Provider Information

NPI Number	:	1528680725
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEVADA MEMORY CARE & ASSISTED LIVING CENTERS LLC

Provider Business Mailing Address
First Line	:	3001 MARSH CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-7049
Country	:	US
Telephone Number	:	702-858-4559
Fax Number	:	810-885-0572

Provider Business Practice Location Address
First Line	:	2299 MONTESSOURI ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-2813
Country	:	US
Telephone Number	:	702-233-9874
Fax Number	:	810-885-0572

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	NICHOLE R CROCK
Credential	:	RFA
Telephone Number	:	702-858-4559

Provider Enumeration Date	:	05/11/2020
Last Update Date	:	03/15/2023

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