MEDICARE: OUR HOME BY MARGARET

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

General Provider Information

NPI Number	:	1841079423
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OUR HOME BY MARGARET

Provider Business Mailing Address
First Line	:	5100 FOGGIA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-7072
Country	:	US
Telephone Number	:	631-935-4583
Fax Number	:

Provider Business Practice Location Address
First Line	:	5100 FOGGIA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-7072
Country	:	US
Telephone Number	:	631-935-4583
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MARGARET MILLER
Credential	:
Telephone Number	:	631-935-4583

Provider Enumeration Date	:	09/25/2023
Last Update Date	:	09/25/2023

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Directions to “OUR HOME BY MARGARET ” Practice Location

Language	Start Address	Practice Location

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