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NPI Code Detail

MEDICARE: DIAMOND CARE VIDA ENCANTADA, LLC

MEDICARE: DIAMOND CARE VIDA ENCANTADA, 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
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1467760892
Entity Type Code : Organization
Provider Name (Legal Business Name) : DIAMOND CARE VIDA ENCANTADA, LLC
Provider Business Mailing Address
First Line : 2301 COLLINS DR
Second Line :
City : LAS VEGAS
State : NM
Zip : 87701-4826
Country : US
Telephone Number : 505-425-9362
Fax Number : 505-425-8518
Provider Business Practice Location Address
First Line : 2301 COLLINS DR
Second Line :
City : LAS VEGAS
State : NM
Zip : 87701-4826
Country : US
Telephone Number : 505-425-9362
Fax Number : 505-425-8518
Authorized Official
Title or Position : MANAGING PARTNER
Name : MR. HARVEY PELOVSKY
Credential :
Telephone Number : 928-978-0520
Provider Enumeration Date : 09/20/2010
Last Update Date : 03/16/2015

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Directions to “DIAMOND CARE VIDA ENCANTADA, LLC ” Practice Location

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