MEDICARE: CARRIE CARE L.L.C

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1629325881
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARRIE CARE L.L.C

Provider Business Mailing Address
First Line	:	2451 N RAINBOW BLVD UNIT 1120
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-4507
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2451 N RAINBOW BLVD UNIT 1120
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-4507
Country	:	US
Telephone Number	:	702-743-9391
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MICHAEL GREEN
Credential	:
Telephone Number	:	702-743-9391

Provider Enumeration Date	:	08/07/2012
Last Update Date	:	08/07/2012

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