Basic Information
| Provider Information | |||||||||
| NPI: | 1174890487 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SBH-MONTEVISTA, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MONTEVISTA HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5900 WEST ROCHELLE AVE | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023641111 | ||||||||
| FaxNumber: | 7023648183 | ||||||||
| Practice Location | |||||||||
| Address1: | 5900 W ROCHELLE AVE | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891033304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023641111 | ||||||||
| FaxNumber: | 7022511212 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2011 | ||||||||
| LastUpdateDate: | 06/13/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CAGLE | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 9019693114 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 283X00000X | N | Hospitals | Rehabilitation Hospital | 283Q00000X | Y | Hospitals | Psychiatric Hospital |
No ID Information.