Provider Demographics
NPI: | 1639637911 |
---|---|
Name: | DIGNITY SELECT NEVADA LLC |
Entity Type: | Organization |
Organization Name: | DIGNITY SELECT NEVADA LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | MANAGER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ELIZABETH |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | GELBAUGH |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 717-972-1100 |
Mailing Address - Street 1: | 4714 GETTYSBURG RD |
Mailing Address - Street 2: | |
Mailing Address - City: | MECHANICSBURG |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 17055-4325 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 717-972-1100 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2904 W HORIZON RIDGE PKWY STE 121 |
Practice Address - Street 2: | |
Practice Address - City: | HENDERSON |
Practice Address - State: | NV |
Practice Address - Zip Code: | 89052-5016 |
Practice Address - Country: | US |
Practice Address - Phone: | 702-897-7331 |
Practice Address - Fax: | 702-897-6801 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2019-03-06 |
Last Update Date: | 2019-03-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QR0400X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation |
Yes | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies |