Provider Demographics
NPI:1104253905
Name:MARY JEWELS HEALTH SERVICES INC
Entity type:Organization
Organization Name:MARY JEWELS HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEWEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DEGUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-201-8585
Mailing Address - Street 1:2224 CANARY WAY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106
Mailing Address - Country:US
Mailing Address - Phone:702-201-8585
Mailing Address - Fax:
Practice Address - Street 1:2224 CANARY WAY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-1912
Practice Address - Country:US
Practice Address - Phone:702-201-8585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-11
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVEO4373920119320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1205183856Medicaid