Provider Demographics
NPI:1225605553
Name:MV ENTERPRISE LLC
Entity Type:Organization
Organization Name:MV ENTERPRISE LLC
Other - Org Name:BETAHNY AT MT HOOD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MYRNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIMZON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-324-3647
Mailing Address - Street 1:1566 MOUNT HOOD ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-1923
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1566 MOUNT HOOD ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-1923
Practice Address - Country:US
Practice Address - Phone:702-354-5121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-07
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1702102040OtherDRIVER LICENSE