Provider Demographics
NPI:1205065869
Name:DEER VALLEY ASSISTED LIVING
Entity type:Organization
Organization Name:DEER VALLEY ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/FOUNDER
Authorized Official - Prefix:MR
Authorized Official - First Name:HOMER
Authorized Official - Middle Name:L
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-287-7356
Mailing Address - Street 1:11102 CIVITA ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-0414
Mailing Address - Country:US
Mailing Address - Phone:702-287-7356
Mailing Address - Fax:702-947-4168
Practice Address - Street 1:8686 GILES RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-1127
Practice Address - Country:US
Practice Address - Phone:702-287-7356
Practice Address - Fax:702-947-4168
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEER VALLEY RECOVERY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV251B00000X, 251C00000X, 251E00000X, 251S00000X, 251V00000X, 252Y00000X
NV2000216.960320600000X
225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or Charitable
No252Y00000XAgenciesEarly Intervention Provider Agency
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities