Healthcare Provider Details

I. General information

NPI: 1720502925
Provider Name (Legal Business Name): LEGACY ADULT DAY SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2017
Last Update Date: 07/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4760 PAHRUMP VALLEY BLVD
PAHRUMP NV
89048-1433
US

IV. Provider business mailing address

1701 BRUCE ST
PAHRUMP NV
89048-6667
US

V. Phone/Fax

Practice location:
  • Phone: 702-816-7735
  • Fax:
Mailing address:
  • Phone: 702-816-7735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNV

VIII. Authorized Official

Name: MARY KAPLAN
Title or Position: PRESIDENT
Credential:
Phone: 702-816-7735