MEDICARE: WELBROOK CENTENNIAL HILLS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	NV20141217507	NV

General Provider Information

NPI Number	:	1215324884
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELBROOK CENTENNIAL HILLS LLC

Provider Business Mailing Address
First Line	:	6650 GRAND MONTECITO PKWY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-0210
Country	:	US
Telephone Number	:	801-683-6565
Fax Number	:

Provider Business Practice Location Address
First Line	:	6650 GRAND MONTECITO PKWY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-0210
Country	:	US
Telephone Number	:	801-683-6565
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MATTHEW RASBAND
Credential	:
Telephone Number	:	801-683-6565

Provider Enumeration Date	:	04/22/2015
Last Update Date	:	03/08/2017

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