Provider Demographics
NPI:1740776871
Name:ROSS SENIOR RESIDENCE
Entity type:Organization
Organization Name:ROSS SENIOR RESIDENCE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRISTI
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-580-3879
Mailing Address - Street 1:5935 W SADDLE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-0118
Mailing Address - Country:US
Mailing Address - Phone:702-365-6124
Mailing Address - Fax:
Practice Address - Street 1:5935 W SADDLE AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-0118
Practice Address - Country:US
Practice Address - Phone:702-365-6124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-01
Last Update Date:2018-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNVS2175AGC251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV=========2Medicaid