Healthcare Provider Details

I. General information

NPI: 1205975356
Provider Name (Legal Business Name): SILVER TOWN INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 12/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5540 SPRING MOUNTAIN RD
LAS VEGAS NV
89146-8809
US

IV. Provider business mailing address

5540 SPRING MOUNTAIN RD
LAS VEGAS NV
89146-8809
US

V. Phone/Fax

Practice location:
  • Phone: 702-365-8882
  • Fax: 702-365-0680
Mailing address:
  • Phone: 702-365-8882
  • Fax: 702-365-0680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number4457ADC-0
License Number StateNV

VIII. Authorized Official

Name: HOWARD CHIN
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 702-365-8882