MEDICARE: SILVER ROCK RECOVERY

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	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1558754747
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SILVER ROCK RECOVERY

Provider Business Mailing Address
First Line	:	4011 MCLEOD DR
Second Line	:	BLDG A
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-4305
Country	:	US
Telephone Number	:	949-467-9213
Fax Number	:

Provider Business Practice Location Address
First Line	:	4011 MCLEOD DR
Second Line	:	BLDG A
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-4305
Country	:	US
Telephone Number	:	949-467-9213
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	STEVE FENNELLY
Credential	:
Telephone Number	:	949-467-9213

Provider Enumeration Date	:	03/11/2015
Last Update Date	:	08/28/2015

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Directions to “SILVER ROCK RECOVERY ” Practice Location

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