MEDICARE: ACCESSIBLE SPACE 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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1649898107
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACCESSIBLE SPACE INC.

Provider Business Mailing Address
First Line	:	6375 W CHARLESTON BLVD BLDG L
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-1139
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4935 N MILLER LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-5201
Country	:	US
Telephone Number	:	702-821-0823
Fax Number	:	702-821-0850

Authorized Official
Title or Position	:	DIRECTOR
Name	:	JERRY KAPPELER
Credential	:
Telephone Number	:	702-259-1903

Provider Enumeration Date	:	07/10/2020
Last Update Date	:	07/10/2020

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