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General NPI Number Information
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NPI Number | 1245704626
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Entity Type | Organization
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Legal Business Name | VILLAS OF LAS VEGAS LLC
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Dates
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Enumeration Date | 01/18/2019
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Last Update Date | 06/15/2020
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Provider Practice Location Address
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Address Line | 9230 CORBETT ST # 101
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City | LAS VEGAS
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State | NV
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Zip | 89149-2337
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Country | US
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Telephone | 718-791-4705
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Fax |
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Provider Business Mailing Address
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Address Line | 2116 JADELEAF CT
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City | LAS VEGAS
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State | NV
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Zip | 89134-6083
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Country | US
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Telephone | 718-791-4705
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MICHELE GOLDMAN
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Credential |
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Telephone | 718-791-4705
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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