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General NPI Number Information
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NPI Number | 1316034598
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Entity Type | Organization
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Legal Business Name | THI OF NEVADA AT HENDERSON CONVALESCENT LLC
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Dates
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Enumeration Date | 10/07/2006
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Last Update Date | 10/10/2011
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Provider Practice Location Address
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Address Line | 1180 E LAKE MEAD PKWY
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City | HENDERSON
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State | NV
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Zip | 89015-5561
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Country | US
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Telephone | 702-565-8555
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Fax | 702-564-6330
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Provider Business Mailing Address
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Address Line | 920 RIDGEBROOK RD
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City | SPARKS
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State | MD
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Zip | 21152-9390
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Country | US
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Telephone | 410-773-1000
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRUCE BEDARD
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Credential |
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Telephone | 702-565-8555
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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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