Provider Demographics
NPI:1275370918
Name:SERVANT'S HEART COMMUNITY CARE SERVICES LLC
Entity type:Organization
Organization Name:SERVANT'S HEART COMMUNITY CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ELLERY
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:RAYFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-800-9839
Mailing Address - Street 1:5550 PAINTED MIRAGE RD STE 320
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-4584
Mailing Address - Country:US
Mailing Address - Phone:702-800-9839
Mailing Address - Fax:702-399-1827
Practice Address - Street 1:539 TERRACE POINT DR
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-1166
Practice Address - Country:US
Practice Address - Phone:702-800-9839
Practice Address - Fax:702-399-1827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home