Healthcare Provider Details

I. General information

NPI: 1285294850
Provider Name (Legal Business Name): QUALITY OF LIFE ADULT DAY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2019
Last Update Date: 06/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 W CHARLESTON BLVD STE 8
LAS VEGAS NV
89146-1143
US

IV. Provider business mailing address

5900 W CHARLESTON BLVD STE 8
LAS VEGAS NV
89146-1143
US

V. Phone/Fax

Practice location:
  • Phone: 702-333-1470
  • Fax: 702-822-6100
Mailing address:
  • Phone: 702-333-1470
  • Fax: 702-822-6100

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: HECTOR CARRILLO
Title or Position: DIRECTOR
Credential:
Phone: 702-333-1470