Spruce Oak Residential Care Facility

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

License

5954AGC-10 Issued in NV

Legal business name

SPRUCE OAK RESIDENTIAL CARE FACILITY

Practice address

4618 Spruce Oak Dr
North Las Vegas, NV 89031-0179

Phone

(702) 462-2031

NPI assigned

Oct 6, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Melissa St Jean

Title

Manager

Phone

(702) 235-9644

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1412553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416873600000",
    "number": "1164825022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4618 SPRUCE OAK DR",
            "city": "NORTH LAS VEGAS",
            "state": "NV",
            "postal_code": "890310179",
            "telephone_number": "702-462-2031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4618 SPRUCE OAK DR",
            "city": "NORTH LAS VEGAS",
            "state": "NV",
            "postal_code": "890310179",
            "telephone_number": "702-462-2031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPRUCE OAK RESIDENTIAL CARE FACILITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-06",
        "last_updated": "2014-11-25",
        "status": "A",
        "authorized_official_last_name": "ST JEAN",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "702-235-9644"
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "NV",
            "license": "5954AGC-10",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tara Spitalny
• Spoken to Art LTD.
• Cheryl Cay Spollino, APRN - FNP
• Brooke Sprasky, RBT
• Jerell Springer
• Kenya Spry
• Sri Caitanya Nitai Inc
• Tina Stabile
• Spring Stacy
• Samella Stafford

• Assisted Living Facility (Mental Illness) in North Las Vegas, NV
• Providers in North Las Vegas, NV by specialty
• Assisted Living Facility (Mental Illness) in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.