MEDICARE: ALEBRIS OF SILVERADO RANCH

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	311ZA0620X	Adult Care Home Facility	3061AGZ-23	NV

General Provider Information

NPI Number	:	1831558568
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALEBRIS OF SILVERADO RANCH

Provider Business Mailing Address
First Line	:	508 PEARBERRY AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89183-7219
Country	:	US
Telephone Number	:	702-897-0925
Fax Number	:	702-897-0926

Provider Business Practice Location Address
First Line	:	508 PEARBERRY AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89183-7219
Country	:	US
Telephone Number	:	702-897-0925
Fax Number	:	702-897-0926

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	CRISTINA LAZAR-LOPEZ
Credential	:
Telephone Number	:	702-235-2584

Provider Enumeration Date	:	02/23/2016
Last Update Date	:	02/23/2016

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