Provider Demographics
NPI:1811043912
Name:DANVILLE SERVICES OF NEVADA, LLC
Entity Type:Organization
Organization Name:DANVILLE SERVICES OF NEVADA, LLC
Other - Org Name:DANVILLE SERVICES CAMERON
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:INOUYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-838-0222
Mailing Address - Street 1:9011 W SAHARA AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-4800
Mailing Address - Country:US
Mailing Address - Phone:702-838-0222
Mailing Address - Fax:702-838-7026
Practice Address - Street 1:7095 CAMERON ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-5018
Practice Address - Country:US
Practice Address - Phone:702-361-1088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVA01-01252-H-113121315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities