MEDICARE: GENTLE BREEZE CARE HOME

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

General Provider Information

NPI Number	:	1568921369
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENTLE BREEZE CARE HOME

Provider Business Mailing Address
First Line	:	6862 BAILE RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-6549
Country	:	US
Telephone Number	:	702-755-1800
Fax Number	:

Provider Business Practice Location Address
First Line	:	6862 BAILE RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-6549
Country	:	US
Telephone Number	:	702-755-1800
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	SOKHENA KENNY HUCH
Credential	:
Telephone Number	:	702-755-1800

Provider Enumeration Date	:	03/19/2019
Last Update Date	:	03/19/2019

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Directions to “GENTLE BREEZE CARE HOME ” Practice Location

Language	Start Address	Practice Location

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