Healthcare Provider Details

I. General information

NPI: 1669211876
Provider Name (Legal Business Name): HENDERSON DELMAR NV OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 05/20/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 DELMAR GARDENS DR
HENDERSON NV
89074-3216
US

IV. Provider business mailing address

1815 LAKEWOOD RD STE 255
TOMS RIVER NJ
08755
US

V. Phone/Fax

Practice location:
  • Phone: 702-361-6111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: ISAAC RAMI
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 702-361-6111