Provider Demographics
NPI:1548702590
Name:FAMILY TREE HEALTH CARE SYSTEMS INC
Entity type:Organization
Organization Name:FAMILY TREE HEALTH CARE SYSTEMS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:GASTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-685-1600
Mailing Address - Street 1:3672 N RANCHO DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-3149
Mailing Address - Country:US
Mailing Address - Phone:702-685-1600
Mailing Address - Fax:702-685-1522
Practice Address - Street 1:3672 N RANCHO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-3149
Practice Address - Country:US
Practice Address - Phone:702-685-1600
Practice Address - Fax:702-685-1522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVNV20161075955Medicaid