Healthcare Provider Details

I. General information

NPI: 1982115911
Provider Name (Legal Business Name): RENEWED MIND ADULT DAY CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2017
Last Update Date: 10/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3211 N TENAYA WAY STE 110-112
LAS VEGAS NV
89129-7439
US

IV. Provider business mailing address

1311 S MARYLAND PKWY
LAS VEGAS NV
89104-3309
US

V. Phone/Fax

Practice location:
  • Phone: 702-772-3663
  • Fax: 702-829-5426
Mailing address:
  • Phone: 702-772-3663
  • 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: FAVOR CHIKELU
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 702-772-3663