Healthcare Provider Details

I. General information

NPI: 1053594937
Provider Name (Legal Business Name): GOOD SHEPHERD REHAB CENTERS OF LAS VEGAS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2007
Last Update Date: 06/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2235 E FLAMINGO ROAD SUITE 170
LAS VEGAS NV
89119
US

IV. Provider business mailing address

P.O. BOX 777851
HENDERSON NV
89077-7851
US

V. Phone/Fax

Practice location:
  • Phone: 702-380-1060
  • Fax: 702-380-1081
Mailing address:
  • Phone: 702-893-3333
  • Fax: 702-893-0960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251C2600X
TaxonomyCardiopulmonary Physical Therapist
License Number
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNV

VIII. Authorized Official

Name: MR. RAUL A ABEJUELA
Title or Position: PRESIDENT/CEO
Credential:
Phone: 702-893-3333