MEDICARE: PREFERRED CARE WEST II 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
1	313M00000X	Nursing Facility/Intermediate Care Facility	181180	NV

General Provider Information

NPI Number	:	1598974487
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREFERRED CARE WEST II INC

Provider Business Mailing Address
First Line	:	2860 E CHEYENNE AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-4234
Country	:	US
Telephone Number	:	702-644-7777
Fax Number	:	702-644-5909

Provider Business Practice Location Address
First Line	:	2860 E CHEYENNE AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-4234
Country	:	US
Telephone Number	:	702-644-7777
Fax Number	:	702-644-5909

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. TROY MALDOVEN
Credential	:
Telephone Number	:	702-644-7777

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	08/22/2020

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