NPIMap

Organization Active NPI

Pam Squared at Las Vegas, LLC

Doing business as PAM Health Rehabilitation Hospital of Henderson

  • Rehabilitation Hospital
  • Henderson, NV
National Provider Identifier
1710765714
Registry record updated Sep 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation HospitalTaxonomy code 283X00000X
Legal business name
PAM SQUARED AT LAS VEGAS, LLC
Doing business as
PAM Health Rehabilitation Hospital of Henderson
Practice address
930 N. Gibson Rd.
Henderson, NV 89011
Phone
(717) 731-9660
NPI assigned
Sep 20, 2023
Last updated
Sep 20, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
PAM SQUARED AT LAS VEGAS, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 20, 2023

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

Authorized official

Name
Mr. Anthony Misitano
Title
President
Phone
(717) 731-9660

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Hospital 283X00000X NU Primary

Addresses

Primary practice location

930 N. Gibson Rd.
Henderson, NV 89011

Mailing address

1828 Good Hope Rd Ste 102
Enola, PA 17025-1203
Phone (717) 731-9660

Other names 1

  • PAM Health Rehabilitation Hospital of Henderson Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170920003084 NV Part A Provider - Hospital 4880968486 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Henderson, NV; Las Vegas, NV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1710765714. Details of each certification follow.

Hospital certification: CCN 293034

Legal name
PAM SQUARED AT LAS VEGAS, LLC
Doing business as
PAM REHABILITATION HOSPITAL OF CENTENNIAL HILLS
Certification status
Active
Provider type (POS)
Hospital – Rehabilitation
Participating since
Jan 9, 2018
Last certification
Jan 28, 2021
Beds
44
Ownership / control type
Private (for profit)
Organization structure
LLCProprietary
Incorporated
Jul 23, 2015 in PA
Enrollment address
6166 N Durango Dr
Las Vegas, NV 89149-3912
Main/Primary Hospital Location
Hospital subgroups
Rehabilitation

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Inpatient rehabilitation facility

Medicare Care Compare
Listed as
Pam Rehabilitation Hospital of Centennial HillsCCN 293034 · All quality measures
Ownership
For profit
Certified
Jan 9, 2018
Medicare certification status
ActiveFrom the Provider of Services file

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
29D2296744Pam Health Rehabilitation Hospital of Henderson930 N Gibson Road, Henderson, NV 89011Certificate of waiverJan 3, 2028

National Provider Directory

National Provider Directory
Tax ID family
Pam Squared at Las Vegas LLC2 organizations share this tax ID, including this one
Part of
Pam Squared at Las Vegas LLC

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 7

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

NameRoleSinceShare
Karick E Stober Individual Corporate OfficerVice President/Treasurer Jul 27, 2015
Anthony F Misitano Individual 5% Or Greater Indirect Ownership Interest Jul 27, 2015 65.67%
Corporate OfficerPresident Jul 27, 2015
Pam Cubed LLC Organization, Enola, PA Chain home office Other Apr 1, 2024
Wells Fargo Bank, N.a. Organization, Minneapolis, MN 5% Or Greater Security Interest Jul 23, 2024
Daniel Kunde Individual W-2 Managing Employee Mar 19, 2023
Brittany Misitano Individual Corporate Officer Apr 2, 2026
Pam Squared, LLC Organization, Enola, PA LLC, For-profit 5% Or Greater Direct Ownership Interest Jul 27, 2015 100%

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Affiliated clinicians 40

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

View all 40

NPI Registry JSON

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

{
    "created_epoch": "1695168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695168000000",
    "number": "1710765714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1828 GOOD HOPE RD STE 102",
            "city": "ENOLA",
            "state": "PA",
            "postal_code": "170251203",
            "telephone_number": "717-731-9660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930 N. GIBSON RD.",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "89011",
            "telephone_number": "717-731-9660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAM SQUARED AT LAS VEGAS, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PAM SQUARED AT LAS VEGAS, LLC",
        "enumeration_date": "2023-09-20",
        "last_updated": "2023-09-20",
        "certification_date": "2023-09-19",
        "status": "A",
        "authorized_official_last_name": "MISITANO",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "717-731-9660",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "283X00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Hospital",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PAM Health Rehabilitation Hospital of Henderson",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Henderson, NV

Sources for this page

Verify at the official NPI Registry.