Healthcare Provider Details

I. General information

NPI: 1730954835
Provider Name (Legal Business Name): LIVINGSTON HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2023
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5858 PALMYRA AVE
LAS VEGAS NV
89146-6733
US

IV. Provider business mailing address

5975 W TWAIN AVE
LAS VEGAS NV
89103-1237
US

V. Phone/Fax

Practice location:
  • Phone: 702-858-4559
  • Fax: 801-885-0572
Mailing address:
  • Phone: 702-368-7700
  • Fax: 810-885-0572

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: MRS. NICHOLE R SCHMAL
Title or Position: ADMINISTRATOR
Credential: RFA
Phone: 702-858-4559