Healthcare Provider Details

I. General information

NPI: 1063071728
Provider Name (Legal Business Name): AS TIME GOES BY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2019
Last Update Date: 06/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4149 JORY TRL
LAS VEGAS NV
89108-5206
US

IV. Provider business mailing address

4125 N BUTLER ST
LAS VEGAS NV
89129-4864
US

V. Phone/Fax

Practice location:
  • Phone: 702-655-7175
  • Fax: 702-655-7175
Mailing address:
  • Phone: 702-655-5557
  • Fax: 702-655-2743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. JUNE KERN
Title or Position: ADMINISTRATOR, OWNER
Credential: RN
Phone: 702-683-4568