Healthcare Provider Details

I. General information

NPI: 1710320619
Provider Name (Legal Business Name): NEW LIFECARE HOSPITAL AT TENAYA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2013
Last Update Date: 03/05/2014
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: 702-562-2021
  • Fax: 702-341-1356
Mailing address:
  • Phone: 469-241-2128
  • Fax: 469-241-2177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number3082HOS-16
License Number StateNV

VIII. Authorized Official

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