Provider Demographics
NPI:1174269385
Name:CARLISLE, RIA DESAMITO
Entity Type:Individual
Prefix:MS
First Name:RIA
Middle Name:DESAMITO
Last Name:CARLISLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 PARADISE VIEW ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-3937
Mailing Address - Country:US
Mailing Address - Phone:702-614-7079
Mailing Address - Fax:702-975-0772
Practice Address - Street 1:1012 PARADISE VIEW ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3937
Practice Address - Country:US
Practice Address - Phone:702-614-7079
Practice Address - Fax:702-975-0772
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4847-AGC311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home