Diamond Care Vida Encantada, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

DIAMOND CARE VIDA ENCANTADA, LLC

Doing business as

Vidan Encantada Nursing and Rehab Center

Practice address

2301 Collins Dr
Las Vegas, NM 87701-4826

Phone

(505) 425-9362

Fax

(505) 425-8518

NPI assigned

Sep 20, 2010

Last updated

Mar 16, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Harvey Pelovsky

Title

Managing Partner

Phone

(928) 978-0520

Specialties & licenses 1

Addresses

Other names 1

• Vidan Encantada Nursing and Rehab Center Doing business as

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

{
    "created_epoch": "1284940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426464000000",
    "number": "1467760892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 COLLINS DR",
            "city": "LAS VEGAS",
            "state": "NM",
            "postal_code": "877014826",
            "telephone_number": "505-425-9362",
            "fax_number": "505-425-8518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 COLLINS DR",
            "city": "LAS VEGAS",
            "state": "NM",
            "postal_code": "877014826",
            "telephone_number": "505-425-9362",
            "fax_number": "505-425-8518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIAMOND CARE VIDA ENCANTADA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-20",
        "last_updated": "2015-03-16",
        "status": "A",
        "authorized_official_last_name": "PELOVSKY",
        "authorized_official_first_name": "HARVEY",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "928-978-0520",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vidan Encantada Nursing and Rehab Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Shannon Delarosbil, BMS
• Caley Nicole Denevers, FNP-BC
• Eric Depopas, M.D.
• Damien Derego, LMHC
• Lot Di Benedetto, DPT
• Dianachavez, LLC
• Rosanne M Dimas
• Wendy Dimmette, M.D.
• Direct Healthcare
• Gabrielle Andrea Dizon, OTR/L

• Skilled Nursing Facility in Las Vegas, NM
• Providers in Las Vegas, NM by specialty
• Skilled Nursing Facility in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.