Healthcare Provider Details

I. General information

NPI: 1598474298
Provider Name (Legal Business Name): MAJESTIC TENDER CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2022
Last Update Date: 11/21/2022
Certification Date: 11/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 E WINDMILL LN
LAS VEGAS NV
89123-1716
US

IV. Provider business mailing address

185 E WINDMILL LN
LAS VEGAS NV
89123-1716
US

V. Phone/Fax

Practice location:
  • Phone: 323-251-7313
  • Fax:
Mailing address:
  • Phone: 323-251-7313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State

VIII. Authorized Official

Name: SHAFIQUE MUSA KAKOOZA
Title or Position: MANAGING MEMBER
Credential:
Phone: 323-251-7313