1174940902 NPI number — NEVADA PREMIER CARE, LLC

Table of content: (NPI 1174940902)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174940902 NPI number — NEVADA PREMIER CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEVADA PREMIER CARE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COMPASSUS PREMIER CARE LAS VEGAS NV
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174940902
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 CADILLAC DRIVE
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-1001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-377-7022
Provider Business Mailing Address Fax Number:
615-373-4457

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3530 E FLAMINGO RD
Provider Second Line Business Practice Location Address:
SUITE 260
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89121-5069
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-836-9232
Provider Business Practice Location Address Fax Number:
702-836-9555
Provider Enumeration Date:
03/18/2014

Additional Information

Authorized Official

Authorized Official Last Name:
JAMES
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
615-425-5418

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , with the licence number:  6388PCS-5 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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