Provider Demographics
NPI:1073561718
Name:MT GRANT GENERAL HOSPITAL
Entity Type:Organization
Organization Name:MT GRANT GENERAL HOSPITAL
Other - Org Name:LEFA L SERAN SKILLED NURSING FACILITY
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHUMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-945-2461
Mailing Address - Street 1:200 SOUTH A STREET
Mailing Address - Street 2:PO BOX 1510
Mailing Address - City:HAWTHORNE
Mailing Address - State:NV
Mailing Address - Zip Code:89415-1510
Mailing Address - Country:US
Mailing Address - Phone:775-945-2461
Mailing Address - Fax:775-945-2359
Practice Address - Street 1:200 SOUTH A STREET
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NV
Practice Address - Zip Code:89415-1510
Practice Address - Country:US
Practice Address - Phone:775-945-2461
Practice Address - Fax:775-945-2359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV651HOS-10314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVNV6028OtherBLUE CROSS
NV=========OtherFEDERAL TAX ID
NV=========OtherCHAMPUS
NV=========OtherFEDERAL TAX ID
NVM29001501Medicare ID - Type UnspecifiedMEDICARE PART B