Healthcare Provider Details

I. General information

NPI: 1356778492
Provider Name (Legal Business Name): BOULDER CITY HOSPITAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2013
Last Update Date: 07/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 ADAMS BLVD
BOULDER CITY NV
89005-2213
US

IV. Provider business mailing address

901 ADAMS BLVD
BOULDER CITY NV
89005-2213
US

V. Phone/Fax

Practice location:
  • Phone: 702-293-4111
  • Fax: 702-293-0430
Mailing address:
  • Phone: 702-293-4111
  • Fax: 702-293-0430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number633RUH-19
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number633RUH-19
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number633RUH-19
License Number StateNV

VIII. Authorized Official

Name: MRS. FREZEWED BELETE
Title or Position: CONTROLLER
Credential:
Phone: 702-294-5711