Healthcare Provider Details

I. General information

NPI: 1033494521
Provider Name (Legal Business Name): THI OF NEVADA II AT DESERT LANE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2011
Last Update Date: 01/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8550 S EASTERN AVENUE
LAS VEGAS NV
89123
US

IV. Provider business mailing address

920 RIDGEBROOK RD
SPARKS MD
21152-9390
US

V. Phone/Fax

Practice location:
  • Phone: 702-382-3155
  • Fax:
Mailing address:
  • Phone: 410-773-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: DARRIN COOK
Title or Position: PRESIDENT
Credential:
Phone: 702-382-3155