Healthcare Provider Details

I. General information

NPI: 1558497784
Provider Name (Legal Business Name): GAYE HAVEN INTERMEDIATE CARE FAC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1813 BETTY LANE
LAS VEGAS NV
89156-6728
US

IV. Provider business mailing address

1813 BETTY LANE
LAS VEGAS NV
89156-6728
US

V. Phone/Fax

Practice location:
  • Phone: 702-452-8399
  • Fax: 702-452-8241
Mailing address:
  • Phone: 702-452-8399
  • Fax: 702-452-8241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number51
License Number StateNV

VIII. Authorized Official

Name: MRS. SANDRA V MANETAS
Title or Position: ADMINISTRATOR
Credential:
Phone: 702-452-8399