Provider Demographics
NPI:1528680725
Name:NEVADA MEMORY CARE & ASSISTED LIVING CENTERS LLC
Entity type:Organization
Organization Name:NEVADA MEMORY CARE & ASSISTED LIVING CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:CROCK
Authorized Official - Suffix:
Authorized Official - Credentials:RFA
Authorized Official - Phone:702-858-4559
Mailing Address - Street 1:3001 MARSH CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-7049
Mailing Address - Country:US
Mailing Address - Phone:702-858-4559
Mailing Address - Fax:810-885-0572
Practice Address - Street 1:2299 MONTESSOURI ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2813
Practice Address - Country:US
Practice Address - Phone:702-233-9874
Practice Address - Fax:810-885-0572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-11
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility