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General NPI Number Information
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NPI Number | 1720575251
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Entity Type | Organization
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Legal Business Name | TANCELL CARE LLC
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Dates
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Enumeration Date | 04/19/2018
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Last Update Date | 06/13/2019
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Provider Practice Location Address
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Address Line | 9138 W RICHMAR AVE
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City | LAS VEGAS
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State | NV
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Zip | 89178-6228
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Country | US
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Telephone | 702-882-4975
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Fax |
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Provider Business Mailing Address
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Address Line | 4000 S EASTERN AVE STE 150
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City | LAS VEGAS
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State | NV
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Zip | 89119-0840
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Country | US
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Telephone | 702-476-0262
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LOUIE NOVELO TANDIONO-CELLONA
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Credential | B.S.
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Telephone | 702-882-4975
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State | NV
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