MEDICARE: WHITE HOUSE SERVICES

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1861902538
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHITE HOUSE SERVICES

Provider Business Mailing Address
First Line	:	3805 FUSELIER DR
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-3003
Country	:	US
Telephone Number	:	702-764-8759
Fax Number	:

Provider Business Practice Location Address
First Line	:	3805 FUSLIER DR
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032
Country	:	US
Telephone Number	:	702-764-8759
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHEDDIE WHITE
Credential	:
Telephone Number	:	702-764-8759

Provider Enumeration Date	:	10/06/2017
Last Update Date	:	10/06/2017

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Directions to “WHITE HOUSE SERVICES ” Practice Location

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