Healthcare Provider Details

I. General information

NPI: 1942723317
Provider Name (Legal Business Name): SUMMERLIN HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2017
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6655 W SAHARA AVE STE D202
LAS VEGAS NV
89146-0867
US

IV. Provider business mailing address

6655 W SAHARA AVE STE D202
LAS VEGAS NV
89146-0867
US

V. Phone/Fax

Practice location:
  • Phone: 702-489-4412
  • Fax: 702-489-4381
Mailing address:
  • Phone: 702-489-4412
  • Fax: 702-489-4381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number StateNV

VIII. Authorized Official

Name: LEE JOHNSON
Title or Position: TREASURER
Credential:
Phone: 208-401-1369