Active NPI
Ria Desamito Carlisle
- Adult Care Home Facility
- Henderson, NV
National Provider Identifier
1174269385
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Care Home Facility
- License
- 4847-AGC
- Practice address
- 1012 Paradise View St
Henderson, NV 89052-3937 - Phone
- (702) 614-7079
- Fax
- (702) 975-0772
- NPI assigned
- May 10, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Care Home Facility | 311ZA0620X | 4847-AGC | NV | Primary |
Addresses
Primary practice location
1012 Paradise View St
Henderson, NV 89052-3937
Mailing address
1012 Paradise View St
Henderson, NV 89052-3937
Phone (702) 614-7079
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4847-AGC | NV | MD | Adult Care Home Facility |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1652140800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1652140800000",
"number": "1174269385",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1012 PARADISE VIEW ST",
"city": "HENDERSON",
"state": "NV",
"postal_code": "890523937",
"telephone_number": "702-614-7079",
"fax_number": "702-975-0772"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1012 PARADISE VIEW ST",
"city": "HENDERSON",
"state": "NV",
"postal_code": "890523937",
"telephone_number": "702-614-7079",
"fax_number": "702-975-0772"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARLISLE",
"first_name": "RIA",
"middle_name": "DESAMITO",
"name_prefix": "Ms.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-05-10",
"last_updated": "2022-05-10",
"certification_date": "2022-05-10",
"status": "A"
},
"taxonomies": [
{
"code": "311ZA0620X",
"taxonomy_group": "",
"desc": "Custodial Care Facility, Adult Care Home",
"state": "NV",
"license": "4847-AGC",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Henderson, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.