MEDICARE: BAILEYS GROUP HOME 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	3104A0625X	Assisted Living Facility (Mental Illness)	7812AGC-O	NV

General Provider Information

NPI Number	:	1770997975
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAILEYS GROUP HOME INC.

Provider Business Mailing Address
First Line	:	1998 ARCANE AVE
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89503-1403
Country	:	US
Telephone Number	:	775-473-7736
Fax Number	:	775-473-7736

Provider Business Practice Location Address
First Line	:	1998 ARCANE AVE
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89503-1403
Country	:	US
Telephone Number	:	775-473-7736
Fax Number	:	775-473-7736

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. PAUL DOUGLAS BAILEY
Credential	:
Telephone Number	:	775-240-4589

Provider Enumeration Date	:	06/16/2014
Last Update Date	:	06/16/2014

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