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NPI Code Detail

MEDICARE: VEGAS ASSISTED LIVING LLC

MEDICARE: VEGAS ASSISTED LIVING 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
1310400000XAssisted Living Facility2089AGC-21NV
2310400000XAssisted Living Facility2089AGC-16NV

General Provider Information

NPI Number : 1790829828
Entity Type Code : Organization
Provider Name (Legal Business Name) : VEGAS ASSISTED LIVING LLC
Provider Business Mailing Address
First Line : PO BOX 3006
Second Line :
City : SALEM
State : OR
Zip : 97302-0006
Country : US
Telephone Number : 503-375-9016
Fax Number : 503-485-1279
Provider Business Practice Location Address
First Line : 6031 CHEYENNE AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89108-4200
Country : US
Telephone Number : 702-658-5882
Fax Number :
Authorized Official
Title or Position : MANAGER
Name : MR. JON M HARDER
Credential :
Telephone Number : 503-375-9016
Provider Enumeration Date : 02/20/2007
Last Update Date : 07/14/2008

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Directions to “VEGAS ASSISTED LIVING LLC ” Practice Location

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