1275370918 NPI number — SERVANT'S HEART COMMUNITY CARE SERVICES LLC

Table of content: MRS. GENIEVEVE JULIA CLINE ARNP (NPI 1790830297)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275370918 NPI number — SERVANT'S HEART COMMUNITY CARE SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SERVANT'S HEART COMMUNITY CARE SERVICES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275370918
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5550 PAINTED MIRAGE RD STE 320
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89149-4584
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-800-9839
Provider Business Mailing Address Fax Number:
702-399-1827

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
539 TERRACE POINT DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89032-1166
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-800-9839
Provider Business Practice Location Address Fax Number:
702-399-1827
Provider Enumeration Date:
07/10/2024

Additional Information

Authorized Official

Authorized Official Last Name:
RAYFORD
Authorized Official First Name:
ELLERY
Authorized Official Middle Name:
AARON
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
702-800-9839

Provider Taxonomy Codes

  • Taxonomy code: 311ZA0620X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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