Healthcare Provider Details

I. General information

NPI: 1841644127
Provider Name (Legal Business Name): NEW VISTA RANCH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2016
Last Update Date: 10/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5220 W CHARLESTON BLVD
LAS VEGAS NV
89146-1345
US

IV. Provider business mailing address

5220 W CHARLESTON BLVD
LAS VEGAS NV
89146-1345
US

V. Phone/Fax

Practice location:
  • Phone: 702-457-4677
  • Fax: 702-457-1433
Mailing address:
  • Phone: 702-457-4677
  • Fax: 702-457-1433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number StateNV

VIII. Authorized Official

Name: MR. ARCHIE C MCARTHUR III
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 702-457-4677