Provider Demographics
NPI:1154790012
Name:UNLV-USC LLC
Entity type:Organization
Organization Name:UNLV-USC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCHESTA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARBURY-HAMMONDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-743-3726
Mailing Address - Street 1:9310 SUN CITY BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-1705
Mailing Address - Country:US
Mailing Address - Phone:702-982-0079
Mailing Address - Fax:
Practice Address - Street 1:9310 SUN CITY BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89134-1705
Practice Address - Country:US
Practice Address - Phone:702-982-0079
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-22
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty