Healthcare Provider Details

I. General information

NPI: 1174446561
Provider Name (Legal Business Name): CORY PLACE CARE HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5616 CORY PL
LAS VEGAS NV
89107-3760
US

IV. Provider business mailing address

5616 CORY PL
LAS VEGAS NV
89107-3760
US

V. Phone/Fax

Practice location:
  • Phone: 702-334-5518
  • Fax:
Mailing address:
  • Phone: 702-334-5518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANNE ESPINUEVA
Title or Position: MANAGING MEMBER
Credential:
Phone: 702-334-5518