Healthcare Provider Details

I. General information

NPI: 1659818839
Provider Name (Legal Business Name): VEGAS ADULT DAYCARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2017
Last Update Date: 01/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 ARVILLE ST
LAS VEGAS NV
89102-0054
US

IV. Provider business mailing address

1130 SHARON RD
LAS VEGAS NV
89106-2036
US

V. Phone/Fax

Practice location:
  • Phone: 702-738-0514
  • Fax: 702-527-7698
Mailing address:
  • Phone: 702-738-0514
  • Fax: 702-527-7698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number8408-ADC-1
License Number StateNV

VIII. Authorized Official

Name: MYONG W KIM
Title or Position: OWNER
Credential:
Phone: 702-738-0514