Healthcare Provider Details

I. General information

NPI: 1568935567
Provider Name (Legal Business Name): MANILA ADULT DAYCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2019
Last Update Date: 05/26/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 KAREN AVE STE B
LAS VEGAS NV
89169-1260
US

IV. Provider business mailing address

8854 CARRADORI AVE
LAS VEGAS NV
89148-4940
US

V. Phone/Fax

Practice location:
  • Phone: 702-323-4020
  • Fax:
Mailing address:
  • Phone: 702-239-9235
  • Fax: 866-782-8154

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: MARICHU PIZAN
Title or Position: DIRECTOR
Credential: NP
Phone: 702-331-5925