MEDICARE: MISSION POINT OF LAS VEGAS LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1144940610
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISSION POINT OF LAS VEGAS LLC

Provider Business Mailing Address
First Line	:	30700 TELEGRAPH RD STE 1510
Second Line	:
City	:	BINGHAM FARMS
State	:	MI
Zip	:	48025-5802
Country	:	US
Telephone Number	:	248-940-5390
Fax Number	:	248-792-9115

Provider Business Practice Location Address
First Line	:	6650 GRAND MONTECITO PKWY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-0210
Country	:	US
Telephone Number	:	248-940-5390
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	HARI S (ROGER) MALI
Credential	:
Telephone Number	:	248-940-5390

Provider Enumeration Date	:	09/02/2022
Last Update Date	:	11/16/2023

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Directions to “MISSION POINT OF LAS VEGAS LLC ” Practice Location

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