Healthcare Provider Details

I. General information

NPI: 1598852774
Provider Name (Legal Business Name): THI OF NEVADA AT LAS VEGAS I, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2006
Last Update Date: 02/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2170 E HARMON AVE
LAS VEGAS NV
89119-7840
US

IV. Provider business mailing address

920 RIDGEBROOK RD
SPARKS MD
21152-9390
US

V. Phone/Fax

Practice location:
  • Phone: 702-794-0100
  • Fax: 702-794-0041
Mailing address:
  • Phone: 410-773-1000
  • Fax:

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: MELISSA RAY
Title or Position: PRESIDENT
Credential:
Phone: 702-794-0100