Healthcare Provider Details

I. General information

NPI: 1629735683
Provider Name (Legal Business Name): SANTA MARIA ADULT DAY HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2021
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 N LAMB BLVD STE 140
LAS VEGAS NV
89110-6355
US

IV. Provider business mailing address

625 N LAMB BLVD STE 140
LAS VEGAS NV
89110-6355
US

V. Phone/Fax

Practice location:
  • Phone: 725-780-1104
  • Fax:
Mailing address:
  • Phone: 725-780-1104
  • Fax:

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: MR. LORENZO TAN JR.
Title or Position: ADMINISTRATOR
Credential:
Phone: 860-977-3215