Provider Demographics
NPI:1245288521
Name:LONG TERM CARE MANAGEMENT, INC.
Entity type:Organization
Organization Name:LONG TERM CARE MANAGEMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:PAVLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-893-8962
Mailing Address - Street 1:5600 SPRING MOUNTAIN RD
Mailing Address - Street 2:SUITE # 207
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-8821
Mailing Address - Country:US
Mailing Address - Phone:702-893-8962
Mailing Address - Fax:
Practice Address - Street 1:1032 N LINCOLN ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95203-2409
Practice Address - Country:US
Practice Address - Phone:209-466-5341
Practice Address - Fax:209-466-5355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
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
CALTC55186FMedicaid
CA55-5186Medicare ID - Type Unspecified