Healthcare Provider Details

I. General information

NPI: 1306032727
Provider Name (Legal Business Name): A & J CARE HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2007
Last Update Date: 09/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5217 W GOWAN RD
LAS VEGAS NV
89130-3118
US

IV. Provider business mailing address

5217 W GOWAN RD
LAS VEGAS NV
89130-3118
US

V. Phone/Fax

Practice location:
  • Phone: 702-645-2291
  • Fax: 702-395-6105
Mailing address:
  • Phone: 702-645-2291
  • Fax: 702-395-6105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number49AGC-13
License Number StateNV

VIII. Authorized Official

Name: MS. JEAN MONTALES TIMBOL
Title or Position: OWNER
Credential:
Phone: 702-755-9833