Provider Demographics
NPI:1942665922
Name:TIMELESS INDIVIDUAL RESIDENTIAL CARE
Entity Type:Organization
Organization Name:TIMELESS INDIVIDUAL RESIDENTIAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:SANDERS
Authorized Official - Last Name:TROUTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-395-5834
Mailing Address - Street 1:4617 SANTA MONICA AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-2831
Mailing Address - Country:US
Mailing Address - Phone:702-395-5834
Mailing Address - Fax:702-645-1020
Practice Address - Street 1:4617 SANTA MONICA AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-2831
Practice Address - Country:US
Practice Address - Phone:702-395-5834
Practice Address - Fax:702-645-1020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4279HIC-9311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home