Provider Demographics
NPI:1881133767
Name:MMMT CORPORATION
Entity type:Organization
Organization Name:MMMT CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:PAVLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-248-0381
Mailing Address - Street 1:5600 SPRING MOUNTAIN RD
Mailing Address - Street 2:SUITE 209
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 1:8225 W ROBINDALE RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113
Practice Address - Country:US
Practice Address - Phone:702-248-0381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-13
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility