Provider Demographics
NPI:1558784686
Name:UTNV LAKES OPERATOR LLC
Entity Type:Organization
Organization Name:UTNV LAKES OPERATOR LLC
Other - Org Name:THE WENTWORTH OF LAS VEGAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED SIGNATORY
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:ASSIRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-769-5882
Mailing Address - Street 1:2620 LAKE SAHARA DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-3439
Mailing Address - Country:US
Mailing Address - Phone:702-233-9800
Mailing Address - Fax:702-233-8899
Practice Address - Street 1:2620 LAKE SAHARA DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-3439
Practice Address - Country:US
Practice Address - Phone:702-233-9800
Practice Address - Fax:702-233-8899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-24
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility