Provider Demographics
NPI:1215324884
Name:WELBROOK CENTENNIAL HILLS LLC
Entity type:Organization
Organization Name:WELBROOK CENTENNIAL HILLS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:RASBAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-683-6565
Mailing Address - Street 1:6650 GRAND MONTECITO PKWY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-0210
Mailing Address - Country:US
Mailing Address - Phone:801-683-6565
Mailing Address - Fax:
Practice Address - Street 1:6650 GRAND MONTECITO PKWY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-0210
Practice Address - Country:US
Practice Address - Phone:801-683-6565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-22
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20141217507314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV295097Medicare Oscar/Certification