Provider Demographics
NPI:1659364248
Name:CORPORACION LAS VEGAS, LLC
Entity type:Organization
Organization Name:CORPORACION LAS VEGAS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ISAMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSAN PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:787-854-1426
Mailing Address - Street 1:PO BOX 1086
Mailing Address - Street 2:RD #2, LAS VEGAS BLDG. #420, BO CAMPO ALEGRE
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-1086
Mailing Address - Country:US
Mailing Address - Phone:787-854-1426
Mailing Address - Fax:787-884-3757
Practice Address - Street 1:CARR 2
Practice Address - Street 2:EDIF LAS VEGAS #420, BO CAMPO ALEGRE
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-5765
Practice Address - Country:US
Practice Address - Phone:787-854-1426
Practice Address - Fax:787-884-3757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-29
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR407014Medicare ID - Type Unspecified