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General NPI Number Information
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NPI Number | 1528427614
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Entity Type | Organization
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Legal Business Name | INTERNATIONAL ADULT DAY CARE
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Dates
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Enumeration Date | 02/17/2016
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Last Update Date | 02/17/2016
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Provider Practice Location Address
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Address Line | 2215 RENAISSANCE DR STE A
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City | LAS VEGAS
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State | NV
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Zip | 89119-6163
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Country | US
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Telephone | 702-405-6393
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Fax | 702-405-6564
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Provider Business Mailing Address
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Address Line | 2215 RENAISSANCE DR STE A
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City | LAS VEGAS
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State | NV
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Zip | 89119-6163
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Country | US
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Telephone | 702-405-6393
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Fax | 702-405-6564
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Authorized Official
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Title or Position | CREDENTIALING/BILLING
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Name | MRS. DELIA R GONZALEZ
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Credential | M.A
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Telephone | 702-258-4900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 2014159531
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License Number State | NV
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