Healthcare Provider Details

I. General information

NPI: 1730726704
Provider Name (Legal Business Name): PALMA HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2019
Last Update Date: 12/09/2019
Certification Date: 12/09/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S 14TH ST
LAS VEGAS NV
89101
US

IV. Provider business mailing address

3312 W CHARLESTON BLVD
LAS VEGAS NV
89102
US

V. Phone/Fax

Practice location:
  • Phone: 702-410-7825
  • Fax:
Mailing address:
  • Phone: 702-410-7825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State

VIII. Authorized Official

Name: FRANCES MALINIS
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 702-410-7825