MEDICARE: COVENANT CARE VEGAS, INC.

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	2340SNF-10	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437299112
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COVENANT CARE VEGAS, INC.

Provider Business Mailing Address
First Line	:	1151 S TORREY PINES DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-9051
Country	:	US
Telephone Number	:	702-938-8333
Fax Number	:	702-938-7149

Provider Business Practice Location Address
First Line	:	1151 S TORREY PINES DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-9051
Country	:	US
Telephone Number	:	702-938-8333
Fax Number	:	702-938-7149

Authorized Official
Title or Position	:	DIRECTOR OF REIMBURSEMENT
Name	:	CAROL SPARKS
Credential	:
Telephone Number	:	949-349-1200

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	11/01/2013

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