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General NPI Number Information
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NPI Number | 1316537665
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Entity Type | Organization
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Legal Business Name | MARIGOLD SUNSET COMBINED HEALTHCARE SERVICES
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Dates
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Enumeration Date | 01/21/2021
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Last Update Date | 01/21/2021
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Provider Practice Location Address
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Address Line | 6554 GRAND CONCOURSE ST
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City | LAS VEGAS
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State | NV
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Zip | 89166-8024
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Country | US
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Telephone | 504-251-8473
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 22001
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City | BULLHEAD CITY
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State | AZ
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Zip | 86439-2001
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. STANFORD COLLINS II
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Credential |
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Telephone | 725-204-2960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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