MEDICARE: DANVILLE SERVICES OF NEVADA, 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	251C00000X	Developmentally Disabled Services Day Training Agency
2	385H00000X	Respite Care

General Provider Information

NPI Number	:	1629610944
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANVILLE SERVICES OF NEVADA, LLC

Provider Business Mailing Address
First Line	:	7351 S UNION PARK AVE STE 200
Second Line	:
City	:	MIDVALE
State	:	UT
Zip	:	84047-1870
Country	:	US
Telephone Number	:	801-316-1111
Fax Number	:	801-561-3956

Provider Business Practice Location Address
First Line	:	718 HARDY WAY
Second Line	:
City	:	MESQUITE
State	:	NV
Zip	:	89027-4300
Country	:	US
Telephone Number	:	702-346-1235
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	WILLIAM ARTHUR WOOLSTON
Credential	:
Telephone Number	:	801-316-1121

Provider Enumeration Date	:	10/09/2019
Last Update Date	:	10/09/2019

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