Provider Demographics
NPI:1275198749
Name:ELKHORN JONES MEMORY CARE LLC
Entity Type:Organization
Organization Name:ELKHORN JONES MEMORY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CROCK
Authorized Official - Suffix:
Authorized Official - Credentials:RFA
Authorized Official - Phone:702-858-4559
Mailing Address - Street 1:6017 ELKHORN RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-3019
Mailing Address - Country:US
Mailing Address - Phone:702-444-4062
Mailing Address - Fax:702-778-6831
Practice Address - Street 1:6017 ELKHORN RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-3019
Practice Address - Country:US
Practice Address - Phone:702-444-4062
Practice Address - Fax:702-778-6831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-09
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)