MEDICARE: PARADISE CREST HOME CARE

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

General Provider Information

NPI Number	:	1922794445
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARADISE CREST HOME CARE

Provider Business Mailing Address
First Line	:	4462 FARMCREST DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-4906
Country	:	US
Telephone Number	:	702-433-2879
Fax Number	:	702-433-2879

Provider Business Practice Location Address
First Line	:	4462 FARMCREST DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-4906
Country	:	US
Telephone Number	:	702-433-2879
Fax Number	:	702-433-2879

Authorized Official
Title or Position	:	OWNER
Name	:	ABDULKADIR TURA
Credential	:
Telephone Number	:	702-466-0554

Provider Enumeration Date	:	04/17/2023
Last Update Date	:	04/17/2023

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Directions to “PARADISE CREST HOME CARE ” Practice Location

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