Healthcare Provider Details

I. General information

NPI: 1730651852
Provider Name (Legal Business Name): SUNRISE ADULT DAY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2018
Last Update Date: 12/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3930 LEON AVE #130
LAS VEGAS NV
89130
US

IV. Provider business mailing address

8866 SANIBEL SHORE AVE
LAS VEGAS NV
89147-6565
US

V. Phone/Fax

Practice location:
  • Phone: 702-468-9994
  • Fax:
Mailing address:
  • Phone: 702-468-9994
  • 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: EUN HEE KIM
Title or Position: ADMINISTRATOR
Credential:
Phone: 702-468-9994