Healthcare Provider Details

I. General information

NPI: 1558784686
Provider Name (Legal Business Name): UTNV LAKES OPERATOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2014
Last Update Date: 01/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 LAKE SAHARA DR
LAS VEGAS NV
89117-3439
US

IV. Provider business mailing address

2620 LAKE SAHARA DR
LAS VEGAS NV
89117-3439
US

V. Phone/Fax

Practice location:
  • Phone: 702-233-9800
  • Fax: 702-233-8899
Mailing address:
  • Phone: 702-233-9800
  • Fax: 702-233-8899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: KENNETH R. ASSIRAN
Title or Position: AUTHORIZED SIGNATORY
Credential:
Phone: 410-769-5882