MEDICARE: SIMPLE LIFE SOLUTIONS,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	251S00000X	Community/Behavioral Health Agency
2	101YA0400X	Addiction (Substance Use Disorder) Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669039996
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIMPLE LIFE SOLUTIONS,LLC

Provider Business Mailing Address
First Line	:	PO BOX 401501
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89140-1501
Country	:	US
Telephone Number	:	702-858-6455
Fax Number	:

Provider Business Practice Location Address
First Line	:	6069 S FORT APACHE RD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5579
Country	:	US
Telephone Number	:	702-858-6455
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	PAULA SHANNON
Credential	:
Telephone Number	:	702-858-6455

Provider Enumeration Date	:	05/22/2019
Last Update Date	:	05/22/2019

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