NPIMap

Organization Active NPI

Thi of Nevada at Cheyenne LLC

Doing business as College Park Rehabilitation Center

  • Skilled Nursing Facility
  • North Las Vegas, NV
National Provider Identifier
1417044694
Registry record updated Oct 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
THI OF NEVADA AT CHEYENNE LLC
Doing business as
College Park Rehabilitation Center
Practice address
2856 E Cheyenne Ave
North Las Vegas, NV 89030-4234
Phone
(702) 644-3269
Fax
(702) 644-2404
NPI assigned
Oct 7, 2006
Last updated
Oct 20, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2016

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

Authorized official

Name
Jonathan Ramey
Title
President
Phone
(702) 644-3269

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

2856 E Cheyenne Ave
North Las Vegas, NV 89030-4234

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
001902230MedicaidNV

Other names 1

  • College Park Rehabilitation Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040618000511 NV Part A Provider - Skilled Nursing Facility 3476538182 Practice locations: North Las Vegas, NV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1417044694. Details of each certification follow.

Skilled nursing facility certification: CCN 295055A

Legal name
THI OF NEVADA AT CHEYENNE, LLC
Doing business as
COLLEGE PARK REHABILITATION CENTER
Organization structure
LLCProprietary
Incorporated
May 19, 2003 in DE
Enrollment address
2856 E Cheyenne Ave
North Las Vegas, NV 89030-4234
Nursing home name
COLLEGE PARK REHABILITATION CENTER
Affiliated entity
FUNDAMENTAL HEALTHCARE

National Provider Directory

National Provider Directory
Tax ID family
College Park Rehab Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Ownership & related parties

All disclosed owners & managing parties 6

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 LLC 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%
Julie Liebo Individual Corporate OfficerPresident Jan 30, 2018
W-2 Managing EmployeeAdministrator/President Jan 30, 2018
Lauren Aufiero Individual Corporate OfficerVP Treasurer Secretary Jul 22, 2008
Thi of Baltimore, Inc. Organization, Sparks, MD For-profit 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 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1160179200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476921600000",
    "number": "1417044694",
    "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": "2856 E CHEYENNE AVE",
            "city": "NORTH LAS VEGAS",
            "state": "NV",
            "postal_code": "890304234",
            "telephone_number": "702-644-3269",
            "fax_number": "702-644-2404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THI OF NEVADA AT CHEYENNE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-07",
        "last_updated": "2016-10-20",
        "status": "A",
        "authorized_official_last_name": "RAMEY",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "702-644-3269"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001902230",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "College Park Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in North Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.