1891853305 NPI number — LORIAN HOME SYSTEMS, INC. OF LAS VEGAS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891853305 NPI number — LORIAN HOME SYSTEMS, INC. OF LAS VEGAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LORIAN HOME SYSTEMS, INC. OF LAS VEGAS
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:
Provider Other Organization Name Type Code:
6
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:
1891853305
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9325 SKY PARK COURT
Provider Second Line Business Mailing Address:
SUITE 310
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-280-8184
Provider Business Mailing Address Fax Number:
619-795-1870

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6325 S. RAINBOW BLVD
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-220-9535
Provider Business Practice Location Address Fax Number:
702-220-9536
Provider Enumeration Date:
12/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
AHUMADA
Authorized Official First Name:
AGUSTIN
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
619-280-8184

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  3453HHA-7 , 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)

  • Identifier: 002902123 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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