Healthcare Provider Details

I. General information

NPI: 1861782294
Provider Name (Legal Business Name): DEER SPRINGS ASSISTED LIVING LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2011
Last Update Date: 04/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6741 N DECATUR BLVD BLDG 3
LAS VEGAS NV
89131-2721
US

IV. Provider business mailing address

295 E WARM SPRINGS RD STE 101
LAS VEGAS NV
89119-4212
US

V. Phone/Fax

Practice location:
  • Phone: 702-462-7700
  • Fax:
Mailing address:
  • Phone: 702-739-3345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number6013AGC-0
License Number StateNV

VIII. Authorized Official

Name: MR. MICHAEL T. MULLIN
Title or Position: PRESIDENT
Credential:
Phone: 702-410-2705