Provider Demographics
NPI:1124718549
Name:NEVADA HABILITATION CENTER
Entity type:Organization
Organization Name:NEVADA HABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMMUNITY LIASON
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILETTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-986-8514
Mailing Address - Street 1:2920 S RAINBOW BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-6214
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2920 S RAINBOW BLVD STE 130
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-6214
Practice Address - Country:US
Practice Address - Phone:702-209-3595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEVADA HABILITATION CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-05-09
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation