Healthcare Provider Details

I. General information

NPI: 1831670843
Provider Name (Legal Business Name): WINDSONG CARE HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2018
Last Update Date: 08/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 WINDSONG ST
LAS VEGAS NV
89145-5150
US

IV. Provider business mailing address

6128 PEGGOTTY AVE
LAS VEGAS NV
89130-1371
US

V. Phone/Fax

Practice location:
  • Phone: 702-815-9998
  • Fax:
Mailing address:
  • Phone: 702-815-9998
  • Fax: 702-998-6919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number8988-AGC-0
License Number StateNV

VIII. Authorized Official

Name: HECTOR MENDOZA
Title or Position: PRESIDENT
Credential:
Phone: 702-815-9998