MEDICARE: PLAZA AT SUN MOUNTAIN

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	310400000X	Assisted Living Facility	2089AGC-16	NV

General Provider Information

NPI Number	:	1518001643
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLAZA AT SUN MOUNTAIN

Provider Business Mailing Address
First Line	:	PO BOX 3006
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-0006
Country	:	US
Telephone Number	:	503-485-4600
Fax Number	:	503-485-1495

Provider Business Practice Location Address
First Line	:	6031 W CHEYENNE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-4200
Country	:	US
Telephone Number	:	704-525-5508
Fax Number	:	503-485-1495

Authorized Official
Title or Position	:	CEO PRESIDENT
Name	:	MR. JON HARDER
Credential	:
Telephone Number	:	503-485-4600

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	08/22/2020

Similar Medicare Providers

1881686855 — LB REGENCY PLAZA LLC
Practice Location Address:

6031 W CHEYENNE AVE
LAS VEGAS, NV
89108-4200

Practice Phone: 702-658-5882
Practice Fax: 702-658-5842

1790829828 — VEGAS ASSISTED LIVING LLC
Practice Location Address:

6031 CHEYENNE AVE
LAS VEGAS, NV
89108-4200

Practice Phone: 702-658-5882
Practice Fax:

1871807073 — EMERITUS CORPORATION
Practice Location Address:

6031 CHEYENNE AVE
LAS VEGAS, NV
89108-4200

Practice Phone: 702-658-5882
Practice Fax: 702-658-5842

1891269759 — LAS VEGAS OPERATIONS, LLC
Practice Location Address:

6031 W CHEYENNE AVE
LAS VEGAS, NV
89108-4200

Practice Phone: 702-658-5882
Practice Fax:

1780454272 — CAPRICE MILES
Practice Location Address:

6031 W CHEYENNE AVE
LAS VEGAS, NV
89108-4200

Practice Phone: 708-491-9833
Practice Fax:

1982456364 — MICHELLE JULIA DE DMON DPT
Practice Location Address:

6031 W CHEYENNE AVE
LAS VEGAS, NV
89108-4200

Practice Phone: 702-658-5882
Practice Fax:

Directions to “PLAZA AT SUN MOUNTAIN ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.