MEDICARE: SOUTH LAS VEGAS MEDICAL INVESTORS, 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	1195SNF-16	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	:	1700837416
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH LAS VEGAS MEDICAL INVESTORS, LLC

Provider Business Mailing Address
First Line	:	3001 KEITH ST NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312-3713
Country	:	US
Telephone Number	:	423-473-5751
Fax Number	:	423-339-8342

Provider Business Practice Location Address
First Line	:	2325 E HARMON AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-7848
Country	:	US
Telephone Number	:	702-798-7990
Fax Number	:	702-798-9910

Authorized Official
Title or Position	:	ASSISTANT SECRETARY
Name	:	CINDY S CROSS
Credential	:
Telephone Number	:	423-473-5867

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	06/09/2016

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