Good Shepherd Rehab Centers of Las Vegas Inc

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

Organization subpart

No

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

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NV

Enrollment records 1

Comprehensive outpatient rehabilitation facility certification: CCN 294507

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

Member of 1

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

• GS Integrated Healthcare Systems, LLC.

  • Home Health Agency
  • Henderson, NV
  • NPI 1881986560

  Member Of

  NPD member

Locations

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Aaron S Allen, RCP

  • General Care Certified Respiratory Therapist
  • Las Vegas, NV
  • NPI 1003101015
  NPD (past)
• David Nathaniel Baldanza, DPT

  • Physical Therapist
  • North Las Vegas, NV
  • NPI 1700244498
  NPD (past)
• Chris Boron, RN

  • Registered Nurse
  • North Las Vegas, NV
  • NPI 1477357796
  NPD (past)
• Shawna Lynn Bryant, MED, LAT, ATC

  • Athletic Trainer
  • Las Vegas, NV
  • NPI 1386270619
  NPD (past)
• Kevin Clemente

  • Physical Therapy Assistant
  • Henderson, NV
  • NPI 1063367001
  NPD (past)
• Owen Clyde Cruz, RT

  • Registered Respiratory Therapist
  • Las Vegas, NV
  • NPI 1770378549
  NPD (past)
• Natasha Nicole Dacalos, PT

  • Physical Therapist
  • Las Vegas, NV
  • NPI 1881572030
  NPD (past)
• Maretes Godinez

  • Case Manager/Care Coordinator
  • Las Vegas, NV
  • NPI 1790343721
  NPD (past)
• Ana Guina

  • Technician
  • Las Vegas, NV
  • NPI 1952073181
  NPD (past)
• Renelie Suba Khoury, RT

  • Certified Respiratory Therapist
  • Las Vegas, NV
  • NPI 1730402967
  NPD (past)
• Maria Virginia Madera, RN

  • Registered Nurse
  • Las Vegas, NV
  • NPI 1962960294
  NPD (past)
• Jon Philip McGill, PT, DPT

  • Physical Therapist
  • Las Vegas, NV
  • NPI 1992354641
  NPD (past)

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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1702161",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DU0139",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Good Shepherd Healthcare II LLC
• Good Shepherd Healthcare LLC
• Good Shepherd Healthcare, LLC
• Good Shepherd Hospice Care Inc
• Good Shepherd Pca Services
• Good Shepherd Rehab Inc.
• Good Shepherd Rehabilitation Institute
• Good Shepherd Rehabilitation Institute Inc
• Good Shepherd Rehabilitation Institute Inc.
• Good Shepherd Rehabilitation Research Institute Inc.

• Physical Therapist in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Physical Therapist in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.