- Enrollment id
- O20040622000444
- Enrollment state
- NV
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1679660864
- Multiple npi flag
- N
- Ccn
- 295036
- Associate id
- 1658356829
- Organization name
- THI OF NEVADA II AT NORTH LAS VEGAS, LLC
- Doing business as name
- NORTH LAS VEGAS CARE CENTER
- Incorporation date
- 2003-07-18
- Incorporation state
- DE
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- NORTH LAS VEGAS CARE CENTER
- Affiliation entity name
- FUNDAMENTAL HEALTHCARE
- Affiliation entity id
- 231
- Address line 1
- 3215 E CHEYENNE AVE
- City
- NORTH LAS VEGAS
- State
- NV
- Zip code
- 890304235