Healthcare Provider Details

I. General information

NPI: 1194906677
Provider Name (Legal Business Name): INDEPENDENT LIVING CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2007
Last Update Date: 11/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 GOLD CREEK DR
DAYTON NV
89403-8405
US

IV. Provider business mailing address

800 N RAINBOW BLVD STE 208
LAS VEGAS NV
89107-1193
US

V. Phone/Fax

Practice location:
  • Phone: 775-297-3387
  • Fax: 702-878-8761
Mailing address:
  • Phone: 702-643-4443
  • Fax: 702-878-8761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State

VIII. Authorized Official

Name: MRS. CAROL J GRAHAM
Title or Position: PRESIDENT
Credential:
Phone: 702-643-4443