Provider Demographics
NPI:1609494756
Name:ST JEREMIAH LLC
Entity Type:Organization
Organization Name:ST JEREMIAH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIETA
Authorized Official - Middle Name:GLORIANI
Authorized Official - Last Name:EMELO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-542-9258
Mailing Address - Street 1:3918 CHEROKEE AVE E
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-4511
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3918 CHEROKEE AVE E
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-4511
Practice Address - Country:US
Practice Address - Phone:702-823-3277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2102248869OtherDRIVER LICENSE