Provider Demographics
NPI:1356778492
Name:BOULDER CITY HOSPITAL INC.
Entity type:Organization
Organization Name:BOULDER CITY HOSPITAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FREZEWED
Authorized Official - Middle Name:
Authorized Official - Last Name:BELETE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-294-5711
Mailing Address - Street 1:901 ADAMS BLVD
Mailing Address - Street 2:
Mailing Address - City:BOULDER CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89005-2213
Mailing Address - Country:US
Mailing Address - Phone:702-293-4111
Mailing Address - Fax:702-293-0430
Practice Address - Street 1:901 ADAMS BLVD
Practice Address - Street 2:
Practice Address - City:BOULDER CITY
Practice Address - State:NV
Practice Address - Zip Code:89005-2213
Practice Address - Country:US
Practice Address - Phone:702-293-4111
Practice Address - Fax:702-293-0430
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOULDER CITY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-03
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV633RUH-19273Y00000X, 282NC0060X, 273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
No273Y00000XHospital UnitsRehabilitation Unit
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV29M309Medicare Oscar/Certification