# CHARLESTON PEDIATRIC SNF LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205504917
- **Authorized official:** MR. DANIEL EVANS MATHIS (CEO)
- **Authorized official phone:** (702) 310-3720

## Contact information

- **Practice address:** 2496 W CHARLESTON BLVD, LAS VEGAS, NV 89102-2179
- **Practice address phone:** (702) 310-3720
- **Practice address fax:** (702) 310-3722
- **Mailing address:** 2496 W CHARLESTON BLVD, LAS VEGAS, NV 89102-2179
- **Mailing address phone:** (702) 310-3720
- **Mailing address fax:** (702) 310-3722

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 08/30/2021
- **Last updated:** 02/13/2025