Provider Demographics
NPI:1558909390
Name:CANYON NEVADA LLC
Entity type:Organization
Organization Name:CANYON NEVADA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:BREEZIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LISKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-456-7874
Mailing Address - Street 1:746 E WINCHESTER ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-8513
Mailing Address - Country:US
Mailing Address - Phone:801-485-6166
Mailing Address - Fax:801-531-1949
Practice Address - Street 1:3100 S NEEDLES HWY STE 500
Practice Address - Street 2:
Practice Address - City:LAUGHLIN
Practice Address - State:NV
Practice Address - Zip Code:89029-0815
Practice Address - Country:US
Practice Address - Phone:702-868-1400
Practice Address - Fax:702-720-1423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-11
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health