Provider Demographics
NPI:1851488043
Name:THI OF NEVADA II AT BOULDER CITY, LLC
Entity Type:Organization
Organization Name:THI OF NEVADA II AT BOULDER CITY, LLC
Other - Org Name:MOUNTAIN VIEW CARE CENTER AT BOULDER CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:BEDINOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-293-5151
Mailing Address - Street 1:930 RIDGEBROOK RD
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:MD
Mailing Address - Zip Code:21152-9390
Mailing Address - Country:US
Mailing Address - Phone:410-773-1000
Mailing Address - Fax:
Practice Address - Street 1:601 ADAMS BLVD
Practice Address - Street 2:
Practice Address - City:BOULDER CITY
Practice Address - State:NV
Practice Address - Zip Code:89005-2219
Practice Address - Country:US
Practice Address - Phone:702-293-5151
Practice Address - Fax:702-293-5782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
295080Medicare ID - Type Unspecified