Healthcare Provider Details

I. General information

NPI: 1023927738
Provider Name (Legal Business Name): ROYAL MOON CARE HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

932 ROYAL MOON AVE
LAS VEGAS NV
89123-0964
US

IV. Provider business mailing address

932 ROYAL MOON AVE
LAS VEGAS NV
89123-0964
US

V. Phone/Fax

Practice location:
  • Phone: 702-847-5444
  • Fax: 702-847-5444
Mailing address:
  • Phone: 702-847-5444
  • Fax: 702-847-5444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER DIAZ
Title or Position: MANAGER
Credential:
Phone: 702-847-5444