Healthcare Provider Details

I. General information

NPI: 1386732659
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: 10/11/2006
Last Update Date: 07/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 S MARTIN L KING BLVD
LAS VEGAS NV
89106-4413
US

IV. Provider business mailing address

920 RIDGEBROOK RD
SPARKS MD
21152-9390
US

V. Phone/Fax

Practice location:
  • Phone: 702-382-3155
  • Fax: 702-384-5659
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: 702-565-8555