MEDICARE: MALAIKA TAMU HADLEY JAFFE

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	320800000X	Mental Illness Community Based Residential Treatment Facility	1811478712	NV

General Provider Information

NPI Number	:	1811478712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALAIKA TAMU HADLEY JAFFE

Provider Business Mailing Address
First Line	:	5450 W SAHARA AVE STE 150
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-0381
Country	:	US
Telephone Number	:	702-957-0049
Fax Number	:

Provider Business Practice Location Address
First Line	:	5450 W SAHARA AVE STE 150
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-0381
Country	:	US
Telephone Number	:	702-306-0571
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2018
Last Update Date	:	06/02/2026

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