Provider Demographics
NPI:1861621013
Name:LAS VEGAS HEALTH SYSTEM LLC
Entity type:Organization
Organization Name:LAS VEGAS HEALTH SYSTEM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA GRACIA
Authorized Official - Middle Name:V
Authorized Official - Last Name:RETRATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-259-0036
Mailing Address - Street 1:3111 S VALLEY VIEW BLVD
Mailing Address - Street 2:SUITE A-216
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-8317
Mailing Address - Country:US
Mailing Address - Phone:702-259-0036
Mailing Address - Fax:702-259-0069
Practice Address - Street 1:3111 S VALLEY VIEW BLVD
Practice Address - Street 2:SUITE A216
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-8317
Practice Address - Country:US
Practice Address - Phone:702-259-0036
Practice Address - Fax:702-259-0069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5512HHA-0251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV032009Medicare UPIN