Provider Demographics
NPI:1396922761
Name:NORTH VISTA HOSPITAL DBA TOTAL CARE MANAGEMENT ASSOCIATES
Entity type:Organization
Organization Name:NORTH VISTA HOSPITAL DBA TOTAL CARE MANAGEMENT ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARINELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-657-5504
Mailing Address - Street 1:10777 W TWAIN AVE
Mailing Address - Street 2:SUITE 225
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-3034
Mailing Address - Country:US
Mailing Address - Phone:702-839-0946
Mailing Address - Fax:702-839-0149
Practice Address - Street 1:2365 REYNOLDS AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-7267
Practice Address - Country:US
Practice Address - Phone:702-399-1287
Practice Address - Fax:702-399-6537
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH VISTA HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV649HOS-22261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center