Organization
THI OF NEVADA AT CHEYENNE LLC
Active
Other names
College Park Rehabilitation Center
Organization subpart
No
Provider details
NPI number
Authorized official
JULIE LIEBO (PRESIDENT)
(702) 644-3269
Entity
Organization
Contact information
Practice address
2856 E CHEYENNE AVE, NORTH LAS VEGAS, NV 89030-4234
(702) 644-3269
Mailing address
920 RIDGEBROOK RD, SPARKS, MD 21152-9390
(410) 773-1175
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
1176SNF15
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100506705
—
NV
Enumeration date
05/25/2007
Last updated
06/28/2011
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