Pacifica Vintage Park LLC

Primary specialty

Alzheimer Center (Dementia Center)Taxonomy code 311500000X

Legal business name

PACIFICA VINTAGE PARK LLC

Practice address

7230 Gagnier Blvd
Las Vegas, NV 89113-4400

Phone

(702) 263-6313

NPI assigned

Oct 22, 2020

Organization subpart

No

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

Authorized official

Name

Deepak Israni

Title

Owner

Phone

(619) 296-9000

Specialties & licenses 1

Addresses

Other names 1

• Legacies Memory Care At San Martin Doing business as

Locations

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

{
    "created_epoch": "1603324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603324800000",
    "number": "1851990691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7230 GAGNIER BLVD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891134400",
            "telephone_number": "702-263-6313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7230 GAGNIER BLVD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891134400",
            "telephone_number": "702-263-6313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFICA VINTAGE PARK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-22",
        "last_updated": "2020-10-22",
        "certification_date": "2020-10-22",
        "status": "A",
        "authorized_official_last_name": "ISRANI",
        "authorized_official_first_name": "DEEPAK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "619-296-9000"
    },
    "taxonomies": [
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Legacies Memory Care At San Martin",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Alzheimer Center (Dementia Center) in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Alzheimer Center (Dementia Center) in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2020; 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.