Healthcare Provider Details

I. General information

NPI: 1932675915
Provider Name (Legal Business Name): HEART TO HEART ADULT DAYCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2018
Last Update Date: 10/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 MARGO DR
LAS VEGAS NV
89122
US

IV. Provider business mailing address

1416 COLT DR
HENDERSON NV
89002
US

V. Phone/Fax

Practice location:
  • Phone: 702-286-7041
  • Fax:
Mailing address:
  • Phone: 702-286-7041
  • 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: MRS. DOROTHY JEAN JACKSON
Title or Position: OWNER/MANAGER
Credential:
Phone: 702-286-7041