Basic Information
| Provider Information | |||||||||
| NPI: | 1396922761 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH VISTA HOSPITAL DBA TOTAL CARE MANAGEMENT ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10777 W TWAIN AVE | ||||||||
| Address2: | SUITE 225 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891353034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028390946 | ||||||||
| FaxNumber: | 7028390149 | ||||||||
| Practice Location | |||||||||
| Address1: | 2365 REYNOLDS AVE | ||||||||
| Address2: | SUITE 111 | ||||||||
| City: | N LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890307267 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023991287 | ||||||||
| FaxNumber: | 7023996537 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2008 | ||||||||
| LastUpdateDate: | 01/28/2008 | ||||||||
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| AuthorizedOfficialLastName: | MARINELLO | ||||||||
| AuthorizedOfficialFirstName: | TONY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7026575504 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NORTH VISTA HOSPITAL, INC. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | 649HOS-22 | NV | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.