Provider Demographics
NPI:1598974487
Name:PREFERRED CARE WEST II INC
Entity Type:Organization
Organization Name:PREFERRED CARE WEST II INC
Other - Org Name:MISSION PINES NURSING AND REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:MALDOVEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-644-7777
Mailing Address - Street 1:2860 E CHEYENNE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-4234
Mailing Address - Country:US
Mailing Address - Phone:702-644-7777
Mailing Address - Fax:702-644-5909
Practice Address - Street 1:2860 E CHEYENNE AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-4234
Practice Address - Country:US
Practice Address - Phone:702-644-7777
Practice Address - Fax:702-644-5909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV181180313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility