Provider Demographics
NPI:1801974340
Name:TRANSITIONAL HOSPITALS CORPORATION OF NEVADA LLC
Entity type:Organization
Organization Name:TRANSITIONAL HOSPITALS CORPORATION OF NEVADA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:K
Authorized Official - Last Name:DILLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-596-7220
Mailing Address - Street 1:102 E LAKE MEAD PKWY
Mailing Address - Street 2:THIRD FLOOR
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-5575
Mailing Address - Country:US
Mailing Address - Phone:702-856-0633
Mailing Address - Fax:702-856-0253
Practice Address - Street 1:102 E LAKE MEAD PKWY
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015
Practice Address - Country:US
Practice Address - Phone:702-856-0633
Practice Address - Fax:702-856-0253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4131HOS-0282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV292002OtherBLUE CROSS
NV100507367Medicaid
NV=========OtherTRICARE/CHAMPUS
NV292002OtherBLUE CROSS
NV=========OtherAETNA
NV=========OtherSECURE HORIZONS
NV=========OtherUNITED HEALTHCARE
NV=========OtherPACIFICARE
NV100507367Medicaid
NV=========OtherPACIFICARE