Healthcare Provider Details

I. General information

NPI: 1497497952
Provider Name (Legal Business Name): LAS VEGAS NV OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2860 E CHEYENNE AVE
NORTH LAS VEGAS NV
89030-4234
US

IV. Provider business mailing address

980 SYLVAN AVE
ENGLEWOOD CLIFFS NJ
07632-3301
US

V. Phone/Fax

Practice location:
  • Phone: 702-644-7777
  • Fax:
Mailing address:
  • Phone: 201-928-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: BATYA GORELICK
Title or Position: COO
Credential:
Phone: 201-928-7800