Healthcare Provider Details

I. General information

NPI: 1891294328
Provider Name (Legal Business Name): VENUS SENIOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2018
Last Update Date: 02/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35145 NEWARK BLVD
NEWARK CA
94560-1219
US

IV. Provider business mailing address

35145 NEWARK BLVD
NEWARK CA
94560-1219
US

V. Phone/Fax

Practice location:
  • Phone: 510-791-2492
  • Fax: 510-494-1525
Mailing address:
  • Phone: 510-791-2492
  • Fax: 510-494-1525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MISS MAYANK PATEL
Title or Position: MANAGING MEMBER
Credential:
Phone: 510-648-8254