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General NPI Number Information
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NPI Number | 1821764135
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Entity Type | Organization
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Legal Business Name | LAS VEGAS GROUP HOME LLC
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Dates
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Enumeration Date | 08/17/2021
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Last Update Date | 08/17/2021
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Provider Practice Location Address
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Address Line | 1680 SOMBRERO DR
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City | LAS VEGAS
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State | NV
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Zip | 89169-2564
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Country | US
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Telephone | 702-209-2580
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Fax | 702-202-4093
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Provider Business Mailing Address
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Address Line | 1680 SOMBRERO DR
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City | LAS VEGAS
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State | NV
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Zip | 89169-2564
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Country | US
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Telephone | 702-209-2580
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Fax | 702-202-4093
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | JOE RABIN
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Credential |
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Telephone | 818-335-2278
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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