MEDICARE: GOOD SHEPHERD REHAB CENTERS OF LAS VEGAS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	225100000X	Physical Therapist
2	2251C2600X	Cardiopulmonary Physical Therapist	NV
3	225100000X	Physical Therapist	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DU0139	OTHER	NV	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053594937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD SHEPHERD REHAB CENTERS OF LAS VEGAS INC

Provider Business Mailing Address
First Line	:	P.O. BOX 777851
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89077-7851
Country	:	US
Telephone Number	:	702-893-3333
Fax Number	:	702-893-0960

Provider Business Practice Location Address
First Line	:	2235 E FLAMINGO ROAD
Second Line	:	SUITE 170
City	:	LAS VEGAS
State	:	NV
Zip	:	89119
Country	:	US
Telephone Number	:	702-380-1060
Fax Number	:	702-380-1081

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MR. RAUL A ABEJUELA
Credential	:
Telephone Number	:	702-893-3333

Provider Enumeration Date	:	12/13/2007
Last Update Date	:	06/27/2016

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Directions to “GOOD SHEPHERD REHAB CENTERS OF LAS VEGAS INC ” Practice Location

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