NPIMap

Organization Active NPI

Good Shepherd Rehab Centers of Las Vegas Inc

  • Physical Therapist
  • Las Vegas, NV
National Provider Identifier
1053594937
Registry record updated Jun 27, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
GOOD SHEPHERD REHAB CENTERS OF LAS VEGAS INC
Practice address
2235 E Flamingo Road
Suite 170
Las Vegas, NV 89119
Phone
(702) 380-1060
Fax
(702) 380-1081
NPI assigned
Dec 13, 2007
Last updated
Jun 27, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Raul A Abejuela
Title
President/Ceo
Phone
(702) 893-3333

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X NV Primary
Cardiopulmonary Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 2251C2600X NV

Addresses

Primary practice location

2235 E Flamingo Road
Suite 170
Las Vegas, NV 89119

Mailing address

P.O. Box 777851
Henderson, NV 89077-7851
Phone (702) 893-3333

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080207000281 NV Part A Provider - Comprehensive Outpatient Rehabilitation Facility 2860575313 Practice locations: Las Vegas, NV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1053594937. Details of each certification follow.

  • CCN 294507 Comprehensive outpatient rehabilitation facility · Active · Name & address match · Details

Comprehensive outpatient rehabilitation facility certification: CCN 294507

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
GOOD SHEPHERD REHAB CENTERS OF LAS VEGAS
Certification status
Active
Provider type (POS)
Comprehensive outpatient rehabilitation facility
Participating since
Mar 4, 2002
Last certification
Feb 24, 2016
Ownership / control type
Proprietary
Facility address
2235 E Flamingo Rd #170
Las Vegas, NV 89119

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

2821 W Horizon Ridge Pkwy
Henderson, NV 89052
Phone (702) 840-1182

2850 W Horizon Ridge Pkwy
Ste 141
Henderson, NV 89052
Phone (702) 623-5077

2904 W Horizon Ridge Pkwy
Ste 200
Henderson, NV 89052
Phone (702) 471-7779

2235 E Flamingo Rd
Ste 170
Las Vegas, NV 89119
Phone (702) 380-1060

4980 W Sahara Ave
Ste 260
Las Vegas, NV 89146
Phone (702) 240-2952

6048 S Durango Dr
Ste 100
Las Vegas, NV 89113
Phone (702) 260-6238

6070 S Fort Apache Rd
Ste 110
Las Vegas, NV 89148
Phone (702) 730-2001

7250 Peak Dr
Ste 118
Las Vegas, NV 89128
Phone (702) 846-2100

7255 S Tenaya Way
Ste 300
Las Vegas, NV 89113
Phone (702) 839-1114

9880 W Flamingo Rd
#260
Las Vegas, NV 89147
Phone (702) 680-0016

6462 N Losee Rd
Ste 135
North Las Vegas, NV 89086
Phone (702) 608-3362

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1197504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466985600000",
    "number": "1053594937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 777851",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890777851",
            "telephone_number": "702-893-3333",
            "fax_number": "702-893-0960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2235 E FLAMINGO ROAD",
            "address_2": "SUITE 170",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "89119",
            "telephone_number": "702-380-1060",
            "fax_number": "702-380-1081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SHEPHERD REHAB CENTERS OF LAS VEGAS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-13",
        "last_updated": "2016-06-27",
        "status": "A",
        "authorized_official_last_name": "ABEJUELA",
        "authorized_official_first_name": "RAUL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "702-893-3333",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "NV",
            "license": null,
            "primary": true
        },
        {
            "code": "2251C2600X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Cardiopulmonary",
            "state": "NV",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.