Healthcare Provider Details

I. General information

NPI: 1447298088
Provider Name (Legal Business Name): THI OF NEVADA II AT DESERT LANE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 07/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 S MARTIN L KING BLVD
LAS VEGAS NV
89106-4413
US

IV. Provider business mailing address

920 RIDGEBROOK RD
SPARKS MD
21152-9390
US

V. Phone/Fax

Practice location:
  • Phone: 702-382-5580
  • Fax:
Mailing address:
  • Phone: 410-773-1000
  • Fax: 410-773-1321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: NICOLE WILK
Title or Position: PRESIDENT
Credential:
Phone: 702-382-5580