Healthcare Provider Details

I. General information

NPI: 1093149130
Provider Name (Legal Business Name): RAY OF SUNSHINE ADULT DAY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2013
Last Update Date: 08/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7720 W SAHARA AVE SUITE 104
LAS VEGAS NV
89117-2799
US

IV. Provider business mailing address

7720 W SAHARA AVE SUITE 104
LAS VEGAS NV
89117-2799
US

V. Phone/Fax

Practice location:
  • Phone: 702-357-7796
  • Fax: 702-454-4663
Mailing address:
  • Phone: 702-357-7796
  • Fax: 702-454-4663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number7681ADC-0
License Number StateNV

VIII. Authorized Official

Name: MRS. CAROLE FRYE
Title or Position: OWNER
Credential:
Phone: 702-357-7796