Provider Demographics
NPI:1649563891
Name:LIFECARE HOSPITAL AT TENAYA LLC
Entity Type:Organization
Organization Name:LIFECARE HOSPITAL AT TENAYA LLC
Other - Org Name:COMPLEX CARE HOSPITAL AT TENAYA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT, REIMBURSEMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CRONIN
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:469-241-2128
Mailing Address - Street 1:5340 LEGACY DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3178
Mailing Address - Country:US
Mailing Address - Phone:469-241-2100
Mailing Address - Fax:469-241-2177
Practice Address - Street 1:2500 N TENAYA WAY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0482
Practice Address - Country:US
Practice Address - Phone:888-735-4933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-20
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV292006Medicare Oscar/Certification