Healthcare Provider Details

I. General information

NPI: 1659545648
Provider Name (Legal Business Name): DEPARTMENT OF VETERANS AFFAIRS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 BAKER BOWL CT
LAS VEGAS NV
89148-4630
US

IV. Provider business mailing address

5555 BAKER BOWL CT
LAS VEGAS NV
89148-4630
US

V. Phone/Fax

Practice location:
  • Phone: 702-653-3633
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License NumberRN53305
License Number StateNV

VIII. Authorized Official

Name: VERNON MANIAGO
Title or Position: REGISTERED NURSE
Credential: RN
Phone: 702-677-1077