Healthcare Provider Details

I. General information

NPI: 1881686855
Provider Name (Legal Business Name): LB REGENCY PLAZA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6031 W CHEYENNE AVE
LAS VEGAS NV
89108-4200
US

IV. Provider business mailing address

6031 W CHEYENNE AVE
LAS VEGAS NV
89108-4200
US

V. Phone/Fax

Practice location:
  • Phone: 702-658-5882
  • Fax: 702-658-5842
Mailing address:
  • Phone: 702-658-5882
  • Fax: 702-658-5842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number2089AGC-9
License Number StateNV

VIII. Authorized Official

Name: JOSEPH C TUTERA
Title or Position: CEO/PRESIDENT
Credential:
Phone: 816-444-0900