Healthcare Provider Details

I. General information

NPI: 1902444557
Provider Name (Legal Business Name): ADULT CARE HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2019
Last Update Date: 12/15/2019
Certification Date: 12/15/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10315 QUEENSBURY AVE
LAS VEGAS NV
89135-2132
US

IV. Provider business mailing address

11838 COGOLETO AVE
LAS VEGAS NV
89138-4687
US

V. Phone/Fax

Practice location:
  • Phone: 702-629-4663
  • Fax: 702-818-4663
Mailing address:
  • Phone: 702-769-5951
  • Fax: 702-818-4663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. KARPAL K PANNU
Title or Position: PRESIDENT
Credential:
Phone: 702-769-5951