Healthcare Provider Details

I. General information

NPI: 1346494119
Provider Name (Legal Business Name): BABY BOOMERS ACTIVITIES CLUB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2008
Last Update Date: 11/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 S JONES BLVD
LAS VEGAS NV
89107-3730
US

IV. Provider business mailing address

850 S JONES BLVD
LAS VEGAS NV
89107-3730
US

V. Phone/Fax

Practice location:
  • Phone: 702-878-9600
  • Fax: 702-878-9605
Mailing address:
  • Phone: 702-878-9600
  • Fax: 702-878-9605

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: KATIUSHKA LOZANO DE POSADA
Title or Position: MANAGING MEMBER
Credential:
Phone: 702-878-9600