NPIMap

Organization Active NPI

State of Nevada

  • Skilled Nursing Facility
  • Boulder City, NV
National Provider Identifier
1083612741
Registry record updated Aug 1, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
2984 SNF-6 Issued in NV
Legal business name
STATE OF NEVADA
Practice address
100 Veterans Memorial Drive
Boulder City, NV 89005
Phone
(702) 332-6713
Fax
(702) 332-6762
NPI assigned
Jul 7, 2005
Last updated
Aug 1, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
NEVADA STATE VETERANS HOMEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 1, 2013

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

Authorized official

Name
Mr. Frank S Bellinger
Title
Administrator
Phone
(702) 332-6713

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Alzheimer Center (Dementia Center) 311500000X 2984 SNF-6 NV
Nursing Facility/Intermediate Care Facility 313M00000X 2984 SNF-6 NV
Skilled Nursing Facility 314000000X 2984 SNF-6 NV Primary

Addresses

Primary practice location

100 Veterans Memorial Drive
Boulder City, NV 89005

Mailing address

100 Veterans Memorial Drive
Boulder City, NV 89005
Phone (702) 332-6713

Other identifiers 1

IdentifierTypeStateIssuer
1902320MedicaidNV

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040804000518 NV Part A Provider - Skilled Nursing Facility 9234022153 Practice locations: Boulder City, NV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1083612741. Details of each certification follow.

Skilled nursing facility certification: CCN 295081

Legal name
STATE OF NEVADA
Doing business as
SOUTHERN NEVADA STATE VETERANS HOME - BOULDER CITY
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Sep 24, 2002
Last certification
Dec 6, 2024
Beds
180
Ownership / control type
State
Organization structure
GovernmentNon-profit
Enrollment address
100 Veterans Memorial Dr
Boulder City, NV 89005-1926
Nursing home name
NEVADA STATE VETERANS HOME - BOULDER CITY

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Nursing home

Medicare Care Compare
Listed as
Nevada State Veterans Home - Boulder CityCCN 295081 · All quality measures
Overall star rating
5 of 5
Health inspections
4 of 5
Staffing
3 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
Government - State
Certified
Sep 24, 2002
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
180167.7 residents per day on average
Penalties (3 years)
1Fines totaling $10,358

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
29D0984237Southern Nevada State Veterans Home100 Veterans Memorial Dr, Boulder City, NV 89005Certificate of waiverMar 15, 2027

National Provider Directory

National Provider Directory
Tax ID family
State of Nevada Bureau125 organizations share this tax ID, including this one
Part of
State of Nevada Bureau

Organizations with this tax ID in the same state 22

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 22

Locations

1330 S Curry St
Carson City, NV 89703
Phone (775) 687-4195

5 Pine Cone Rd
Dayton, NV 89403
Phone (775) 246-7742

1665 Avenue F
Ely, NV 89301
Phone (775) 289-1671

85 N Taylor St
Fallon, NV 89406
Phone (775) 423-4434

115 W Main St
Fernley, NV 89408
Phone (775) 575-0670

1133 Spruce St
Gardnerville, NV 89410
Phone (702) 329-9010

1538 US Highway 395 N
#100
Gardnerville, NV 89410
Phone (775) 782-3671

4045 Spencer St
Ste 300
Las Vegas, NV 89119
Phone (702) 486-3800

61 N Willow St
Ste 4
Mesquite, NV 89027
Phone (702) 346-4696

1981 E Calvada Blvd
Apt 100
Pahrump, NV 89048
Phone (775) 751-7070

240 S Humahuaca St
Pahrump, NV 89048
Phone (775) 751-7406

885 Trademark Dr
Ste 150
Reno, NV 89521
Phone (800) 856-8839

1060 Idaho Ave
Bldg A
Silver Springs, NV 89429
Phone (702) 577-0319

2475 Fort Churchill Rd
Silver Springs, NV 89429
Phone (775) 577-5016

102 E Haskell St
Community Health Clinics
Winnemucca, NV 89445
Phone (775) 623-6575

102E Haskell St
Winnemucca, NV 89445
Phone (775) 623-6575

215 W Bridge St
Ste 5
Yerington, NV 89447
Phone (775) 463-3191

Ownership & related parties

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Susan Doran Individual Operational/Managerial Control May 8, 2012
Adp of the SNF May 8, 2012
Kate Baltazar-Dodge Individual Operational/Managerial Control Mar 11, 2024
Adp of the SNF Mar 11, 2024
Jennifer M Fuller Individual Operational/Managerial Control May 13, 2024
Adp of the SNF May 13, 2024
State of Nevada Organization, Reno, NV 5% Or Greater Direct Ownership Interest Sep 24, 2002 100%
Operational/Managerial Control Sep 24, 2002
Adp of the SNF Sep 24, 2002
Craig M Jorgenson Individual Operational/Managerial Control Oct 1, 2004
Adp of the SNF Oct 1, 2004

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

  • Craig M Jorgenson, MD
    • Internal Medicine Physician
    • Las Vegas, NV
    • NPI 1588646830

    Adp of the SNF, Operational/Managerial Control

    CMS ownership
  • Southern Nevada Adult Mental Health
    • Adult Mental Health Clinic/Center
    • Las Vegas, NV
    • NPI 1891756920

    5% Or Greater Direct Ownership Interest, Adp of the SNF, Operational/Managerial Control

    CMS ownership
  • State of Nevada

    dba Ely Mental Health Center

    • Mental Health Clinic/Center (Including Community Mental Health Center)
    • Ely, NV
    • NPI 1760572010

    5% Or Greater Direct Ownership Interest, Adp of the SNF, Operational/Managerial Control

    CMS ownership
  • State of Nevada

    dba Northern Nevada Adult Mental Health Services

    • Psychiatric Hospital
    • Sparks, NV
    • NPI 1972501021

    5% Or Greater Direct Ownership Interest, Adp of the SNF, Operational/Managerial Control

    CMS ownership

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Northern Nevada Adult Mental Health ServicesSparks, NV, CCN 294000 Hospital Other May 6, 2013
Southern Nevada Adult Mental Health ServicesLas Vegas, NV, CCN 294002 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966
Northern Nevada State Veterans HomeSparks, NV, CCN 295105 Skilled nursing facility Adp of the SNF Feb 15, 2019

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 186

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 186

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375315200000",
    "number": "1083612741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 VETERANS MEMORIAL DRIVE",
            "city": "BOULDER CITY",
            "state": "NV",
            "postal_code": "89005",
            "telephone_number": "702-332-6713",
            "fax_number": "702-332-6762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 VETERANS MEMORIAL DRIVE",
            "city": "BOULDER CITY",
            "state": "NV",
            "postal_code": "89005",
            "telephone_number": "702-332-6713",
            "fax_number": "702-332-6762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF NEVADA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NEVADA STATE VETERANS HOME",
        "enumeration_date": "2005-07-07",
        "last_updated": "2013-08-01",
        "status": "A",
        "authorized_official_last_name": "BELLINGER",
        "authorized_official_first_name": "FRANK",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "702-332-6713",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": "NV",
            "license": "2984 SNF-6",
            "primary": false
        },
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "NV",
            "license": "2984 SNF-6",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NV",
            "license": "2984 SNF-6",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1902320",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boulder City, NV

Sources for this page

Verify at the official NPI Registry.