NPIMap

Organization Active NPI

Thi of Nevada II at Desert Lane, LLC

  • Long Term Care Hospital
  • Las Vegas, NV
National Provider Identifier
1386732659
Registry record updated Jul 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care HospitalTaxonomy code 282E00000X
Legal business name
THI OF NEVADA II AT DESERT LANE, LLC
Practice address
640 S Martin L King Blvd
Las Vegas, NV 89106-4413
Phone
(702) 382-3155
Fax
(702) 384-5659
NPI assigned
Oct 11, 2006
Last updated
Jul 25, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2019

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

Authorized official

Name
Darrin Cook
Title
President
Phone
(702) 565-8555

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Hospital 282E00000X NU Primary

Addresses

Primary practice location

640 S Martin L King Blvd
Las Vegas, NV 89106-4413

Mailing address

920 Ridgebrook Rd
Sparks, MD 21152-9390
Phone (410) 773-1000

Other practice location 1

8550 S Eastern Ave
Las Vegas, NV 89123-2835
Phone (702) 382-3155

Other identifiers 1

IdentifierTypeStateIssuer
5602006MedicaidNV

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040618000628 NV Part A Provider - Hospital 2365427093 Practice locations: Las Vegas, NV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386732659. Details of each certification follow.

Hospital certification: CCN 292003

Legal name
THI OF NEVADA II AT DESERT LANE, LLC
Doing business as
HORIZON SPECIALTY HOSPITAL OF LAS VEGAS
Certification status
Active
Provider type (POS)
Hospital – Long-term
Participating since
Jun 1, 1994
Last certification
Oct 7, 2021
Beds
199 (61 certified)
Ownership / control type
Private (for profit)
Most recent change of ownership
Oct 28, 1998 (1 total)
Organization structure
LLCProprietary
Incorporated
Jul 18, 2003 in DE
Enrollment address
640 S Martin Luther King Blvd
Las Vegas, NV 89106-4445
Other Hospital Practice Location
Hospital subgroups
Rehabilitation

Other NPIs with the same Medicare PAC ID 1

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

Care Compare: Long-term care hospital

Medicare Care Compare
Listed as
Horizon Specialty HospitalCCN 292003 · All quality measures
Ownership
For profit
Certified
Jun 1, 1994
Medicare certification status
ActiveFrom the Provider of Services file
Beds
199

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
29D1105968Horizon Specialty Hospital of Las Vegas640 South Martin Luther King Blvd, Las Vegas, NV 89106AccreditationAug 11, 2027

National Provider Directory

National Provider Directory
Tax ID family
Thi of Nevada II at Desert Lane LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

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
Thi of Nevada II Inc Organization, Las Vegas, NV For-profit 5% Or Greater Direct Ownership Interest Aug 30, 2003 100%
Murray Forman Individual 5% Or Greater Indirect Ownership Interest Mar 28, 2006 100%
Darrin Cook Individual Corporate OfficerPresident Oct 1, 2014
W-2 Managing EmployeeAdministrator and President Oct 1, 2014
Thi of Baltimore, Inc. Organization, Sparks, MD Corporation 5% Or Greater Indirect Ownership Interest Aug 30, 2003 100%
Hunt Valley Holdings LLC Organization, Sparks, MD For-profit 5% Or Greater Indirect Ownership Interest Mar 28, 2006 100%

Facilities with the same owner 40

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

View all 40

Practitioners & affiliated clinicians

Practitioners 8

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.

Affiliated clinicians 8

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": "1160524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564012800000",
    "number": "1386732659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 RIDGEBROOK RD",
            "city": "SPARKS",
            "state": "MD",
            "postal_code": "211529390",
            "telephone_number": "410-773-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 S MARTIN L KING BLVD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891064413",
            "telephone_number": "702-382-3155",
            "fax_number": "702-384-5659"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8550 S Eastern Ave",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891232835",
            "country_code": "US",
            "telephone_number": "702-382-3155",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "THI OF NEVADA II AT DESERT LANE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-11",
        "last_updated": "2019-07-25",
        "status": "A",
        "authorized_official_last_name": "COOK",
        "authorized_official_first_name": "DARRIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "702-565-8555"
    },
    "taxonomies": [
        {
            "code": "282E00000X",
            "taxonomy_group": "",
            "desc": "Long Term Care Hospital",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5602006",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.