Healthcare Provider Details

I. General information

NPI: 1871065508
Provider Name (Legal Business Name): GRACE OF MONACO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2018
Last Update Date: 12/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7952 MONACO BAY CT
LAS VEGAS NV
89117-2512
US

IV. Provider business mailing address

7952 MONACO BAY CT
LAS VEGAS NV
89117-2512
US

V. Phone/Fax

Practice location:
  • Phone: 702-984-6059
  • Fax: 702-984-6059
Mailing address:
  • Phone: 702-984-6059
  • Fax: 702-984-6059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. RAMONCITO E GARCIA
Title or Position: MANAGING MEMBER
Credential:
Phone: 702-236-6642