Healthcare Provider Details

I. General information

NPI: 1598156267
Provider Name (Legal Business Name): GOLDEN AGES ADULT DAYCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2015
Last Update Date: 02/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 E BONANZA RD BLDG D STE 160
LAS VEGAS NV
89101-3702
US

IV. Provider business mailing address

3020 E BONANZA RD BLDG D STE 160
LAS VEGAS NV
89101-3702
US

V. Phone/Fax

Practice location:
  • Phone: 702-427-5307
  • Fax:
Mailing address:
  • Phone: 702-427-5307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number8122ADC-0
License Number StateNV

VIII. Authorized Official

Name: MS. DENNYS BAUTISTA
Title or Position: DIRECTOR
Credential:
Phone: 702-427-5307