Provider Demographics
NPI:1104466416
Name:MJM VENTURES LLC
Entity type:Organization
Organization Name:MJM VENTURES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOY MARIE
Authorized Official - Middle Name:BANZON
Authorized Official - Last Name:VILLAMORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-405-7992
Mailing Address - Street 1:3700 PORTIANI DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-6149
Mailing Address - Country:US
Mailing Address - Phone:702-286-4603
Mailing Address - Fax:702-405-7920
Practice Address - Street 1:3663 E SUNSET RD STE 503
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-3299
Practice Address - Country:US
Practice Address - Phone:702-405-7992
Practice Address - Fax:702-405-7920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-14
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0404XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Cardiac Facilities
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVNV20191507489OtherSTATE OF NEVADA