Provider Demographics
NPI:1538614961
Name:AMERICAN SENIOR HOME LLC
Entity type:Organization
Organization Name:AMERICAN SENIOR HOME LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:
Authorized Official - Last Name:FARAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-403-3661
Mailing Address - Street 1:185 E WINDMILL LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-1716
Mailing Address - Country:US
Mailing Address - Phone:702-403-3661
Mailing Address - Fax:
Practice Address - Street 1:185 E WINDMILL LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-1716
Practice Address - Country:US
Practice Address - Phone:702-444-0792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8576-AGC-0311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)