Healthcare Provider Details

I. General information

NPI: 1649563891
Provider Name (Legal Business Name): LIFECARE HOSPITAL AT TENAYA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2011
Last Update Date: 10/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N TENAYA WAY
LAS VEGAS NV
89128-0482
US

IV. Provider business mailing address

5340 LEGACY DR SUITE 150
PLANO TX
75024-3178
US

V. Phone/Fax

Practice location:
  • Phone: 888-735-4933
  • Fax:
Mailing address:
  • Phone: 469-241-2100
  • Fax: 469-241-2177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. JOHN MICHAEL CRONIN
Title or Position: VICE PRESIDENT, REIMBURSEMENT
Credential: CPA
Phone: 469-241-2128