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General NPI Number Information
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NPI Number | 1568968733
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Entity Type | Organization
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Legal Business Name | GOLDEN LAKE CARE HOME
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Dates
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Enumeration Date | 04/04/2018
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Last Update Date | 04/04/2018
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Provider Practice Location Address
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Address Line | 9719 TUMBLE LAKE CT
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City | LAS VEGAS
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State | NV
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Zip | 89147-6749
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Country | US
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Telephone | 702-755-1800
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Fax |
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Provider Business Mailing Address
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Address Line | 9719 TUMBLE LAKE CT
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City | LAS VEGAS
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State | NV
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Zip | 89147-6749
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Country | US
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Telephone | 702-755-1800
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Fax |
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Authorized Official
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Title or Position | EMPLOYEE/AGENT
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Name | SOKHENA K HUCH
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Credential |
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Telephone | 702-755-1800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 7557-AGC-7
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License Number State | NV
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