Organization
THI OF NEVADA II AT DESERT LANE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE WILK (PRESIDENT)
(702) 382-5580
Entity
Organization
Contact information
Practice address
660 S MARTIN L KING BLVD, LAS VEGAS, NV 89106-4413
(702) 382-5580
Mailing address
920 RIDGEBROOK RD, SPARKS, MD 21152-9390
(410) 773-1000
(410) 773-1321
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001902838
—
NV
Enumeration date
06/04/2006
Last updated
07/25/2019
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