Healthcare Provider Details

I. General information

NPI: 1083356752
Provider Name (Legal Business Name): EL JEN SNF OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 07/15/2022
Certification Date: 07/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5538 DUNCAN DR
LAS VEGAS NV
89130-2812
US

IV. Provider business mailing address

5538 DUNCAN DR
LAS VEGAS NV
89130-2812
US

V. Phone/Fax

Practice location:
  • Phone: 702-645-2606
  • Fax:
Mailing address:
  • Phone: 702-645-2606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. YITZCHOK YENOWITZ
Title or Position: MANAGER
Credential:
Phone: 347-693-4239