MEDICARE: LAS VEGAS GROUP HOME AT LAKE MEAD

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

General Provider Information

NPI Number	:	1760320808
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAS VEGAS GROUP HOME AT LAKE MEAD

Provider Business Mailing Address
First Line	:	5399 W LAKE MEAD BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-3051
Country	:	US
Telephone Number	:	702-806-5947
Fax Number	:

Provider Business Practice Location Address
First Line	:	5399 W LAKE MEAD BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-3051
Country	:	US
Telephone Number	:	702-806-5947
Fax Number	:

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	RAFIQ N PRICE
Credential	:
Telephone Number	:	702-806-5947

Provider Enumeration Date	:	03/23/2026
Last Update Date	:	03/23/2026

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