MEDICARE: GAYE HAVEN INTERMEDIATE CARE FAC

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	313M00000X	Nursing Facility/Intermediate Care Facility	51	NV

General Provider Information

NPI Number	:	1558497784
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GAYE HAVEN INTERMEDIATE CARE FAC

Provider Business Mailing Address
First Line	:	1813 BETTY LANE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89156-6728
Country	:	US
Telephone Number	:	702-452-8399
Fax Number	:	702-452-8241

Provider Business Practice Location Address
First Line	:	1813 BETTY LANE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89156-6728
Country	:	US
Telephone Number	:	702-452-8399
Fax Number	:	702-452-8241

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. SANDRA V MANETAS
Credential	:
Telephone Number	:	702-452-8399

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	08/22/2020

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