Healthcare Provider Details

I. General information

NPI: 1275198749
Provider Name (Legal Business Name): ELKHORN JONES MEMORY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2019
Last Update Date: 04/21/2020
Certification Date: 04/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6017 ELKHORN RD
LAS VEGAS NV
89131-3019
US

IV. Provider business mailing address

6017 ELKHORN RD
LAS VEGAS NV
89131-3019
US

V. Phone/Fax

Practice location:
  • Phone: 702-444-4062
  • Fax: 702-778-6831
Mailing address:
  • Phone: 702-444-4062
  • Fax: 702-778-6831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: NICHOLE CROCK
Title or Position: ADMINISTRATOR
Credential: RFA
Phone: 702-858-4559