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General NPI Number Information
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NPI Number | 1205563863
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Entity Type | Organization
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Legal Business Name | SOUTHERN NEVADA CARE CENTER
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Dates
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Enumeration Date | 08/04/2022
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Last Update Date | 08/04/2022
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Provider Practice Location Address
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Address Line | 1330 KAREN AVE UNIT B
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City | LAS VEGAS
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State | NV
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Zip | 89169-1260
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Country | US
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Telephone | 702-625-0022
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Fax |
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Provider Business Mailing Address
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Address Line | 1330 KAREN AVE UNIT B
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City | LAS VEGAS
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State | NV
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Zip | 89169-1260
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Country | US
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Telephone | 702-625-0022
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MARICHU PIZAN
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Credential | NP
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Telephone | 702-800-5393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number |
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License Number State |
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