Provider Demographics
NPI:1205563863
Name:SOUTHERN NEVADA CARE CENTER
Entity type:Organization
Organization Name:SOUTHERN NEVADA CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARICHU
Authorized Official - Middle Name:
Authorized Official - Last Name:PIZAN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:702-800-5393
Mailing Address - Street 1:1330 KAREN AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-1260
Mailing Address - Country:US
Mailing Address - Phone:702-625-0022
Mailing Address - Fax:
Practice Address - Street 1:1330 KAREN AVE UNIT B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-1260
Practice Address - Country:US
Practice Address - Phone:702-625-0022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHERN NEVADA CARE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1801485131Medicaid