Provider Demographics
NPI:1720818933
Name:GREEN VALLEY MEMORY CARE
Entity type:Organization
Organization Name:GREEN VALLEY MEMORY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANALYN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUA DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-863-6095
Mailing Address - Street 1:2321 THAYER AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-5367
Mailing Address - Country:US
Mailing Address - Phone:702-476-8588
Mailing Address - Fax:
Practice Address - Street 1:2321 THAYER AVE
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-5367
Practice Address - Country:US
Practice Address - Phone:702-476-8588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)