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NPI Code Detail

MEDICARE: ST. JOSEPH TRANSITIONAL REHABILITATION CENTER, LLC

MEDICARE: ST. JOSEPH TRANSITIONAL REHABILITATION CENTER, 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
1314000000XSkilled Nursing Facility1182SNF-20NV

Other Identifiers

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

General Provider Information

NPI Number : 1346289113
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST. JOSEPH TRANSITIONAL REHABILITATION CENTER, LLC
Provider Business Mailing Address
First Line : 2035 W CHARLESTON BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-2223
Country : US
Telephone Number : 702-386-7980
Fax Number : 702-386-4833
Provider Business Practice Location Address
First Line : 2035 W CHARLESTON BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-2223
Country : US
Telephone Number : 702-386-7980
Fax Number : 702-386-4833
Authorized Official
Title or Position : ASSISTANT SECRETARY
Name : MICHAEL T. BERG
Credential :
Telephone Number : 505-468-4752
Provider Enumeration Date : 06/06/2006
Last Update Date : 09/06/2017

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