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General NPI Number Information
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NPI Number | 1255847547
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Entity Type | Organization
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Legal Business Name | MORNING STAR CARE HOME
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Dates
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Enumeration Date | 12/21/2017
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Last Update Date | 01/19/2018
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Provider Practice Location Address
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Address Line | 7560 SILVER LEAF WAY
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City | LAS VEGAS
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State | NV
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Zip | 89147-4957
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Country | US
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Telephone | 702-301-5877
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Fax |
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Provider Business Mailing Address
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Address Line | 7560 SILVER LEAF WAY
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City | LAS VEGAS
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State | NV
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Zip | 89147-4957
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Country | US
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Telephone | 702-301-5877
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Fax |
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MR. ROMEO VILLANUEVA BALGAN
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Credential |
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Telephone | 702-301-5877
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376G00000X
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Taxonomy Name | Nursing Home Administrator
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License Number | 7075
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License Number State | NV
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