MEDICARE: RENEWED MIND ADULT DAY CARE CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1982115911
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENEWED MIND ADULT DAY CARE CENTER

Provider Business Mailing Address
First Line	:	1311 S MARYLAND PKWY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-3309
Country	:	US
Telephone Number	:	702-772-3663
Fax Number	:

Provider Business Practice Location Address
First Line	:	3211 N TENAYA WAY STE 110-112
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-7439
Country	:	US
Telephone Number	:	702-772-3663
Fax Number	:	702-829-5426

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	FAVOR CHIKELU
Credential	:
Telephone Number	:	702-772-3663

Provider Enumeration Date	:	10/17/2017
Last Update Date	:	10/17/2017

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