Provider Demographics
NPI:1376197707
Name:CLAYTON, BRISTURE
Entity Type:Individual
Prefix:
First Name:BRISTURE
Middle Name:
Last Name:CLAYTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SAFE AT HOME LLC
Mailing Address - Street 2:1775 E TROPICANA AVE STE 16
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119
Mailing Address - Country:US
Mailing Address - Phone:702-963-6044
Mailing Address - Fax:
Practice Address - Street 1:SAFE AT HOME LLC
Practice Address - Street 2:1775 E TROPICANA AVE STE 16
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119
Practice Address - Country:US
Practice Address - Phone:702-963-6044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant