Provider Demographics
NPI:1053594937
Name:GOOD SHEPHERD REHAB CENTERS OF LAS VEGAS INC
Entity type:Organization
Organization Name:GOOD SHEPHERD REHAB CENTERS OF LAS VEGAS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ABEJUELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-893-3333
Mailing Address - Street 1:P.O. BOX 777851
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89077-7851
Mailing Address - Country:US
Mailing Address - Phone:702-893-3333
Mailing Address - Fax:702-893-0960
Practice Address - Street 1:2235 E FLAMINGO ROAD
Practice Address - Street 2:SUITE 170
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119
Practice Address - Country:US
Practice Address - Phone:702-380-1060
Practice Address - Fax:702-380-1081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
NV225100000X, 2251C2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251C2600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistCardiopulmonaryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1702161Medicaid
NVDU0139OtherRAILROAD MEDICARE
NV1702161Medicaid
NVGC779AMedicare PIN
NV294507Medicare PIN
NV1702161Medicaid
NV294507Medicare PIN