Healthcare Provider Details

I. General information

NPI: 1811421712
Provider Name (Legal Business Name): HENDERSON LONG TERM CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2017
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2965 WIGWAM PKWY
HENDERSON NV
89074-2870
US

IV. Provider business mailing address

2965 WIGWAM PKWY
HENDERSON NV
89074-2870
US

V. Phone/Fax

Practice location:
  • Phone: 702-470-2020
  • Fax:
Mailing address:
  • Phone: 702-470-2020
  • 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: DARRIN COOK
Title or Position: PRESIDENT
Credential:
Phone: 702-470-2020