Basic Information
| Provider Information | |||||||||
| NPI: | 1881686855 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LB REGENCY PLAZA LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | THE PLAZA AT SUN MOUNTAIN | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6031 W CHEYENNE AVE | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891084200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026585882 | ||||||||
| FaxNumber: | 7026585842 | ||||||||
| Practice Location | |||||||||
| Address1: | 6031 W CHEYENNE AVE | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891084200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026585882 | ||||||||
| FaxNumber: | 7026585842 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | TUTERA | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8164440900 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | 2089AGC-9 | NV | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.