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NPI Code Detail

MEDICARE: GOLDEN AGES ADULT DAYCARE LLC

MEDICARE: GOLDEN AGES ADULT DAYCARE LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QA0600XAdult Day Care Clinic/Center8122ADC-0NV

General Provider Information

NPI Number : 1598156267
Entity Type Code : Organization
Provider Name (Legal Business Name) : GOLDEN AGES ADULT DAYCARE LLC
Provider Business Mailing Address
First Line : 3020 E BONANZA RD
Second Line : BLDG D STE 160
City : LAS VEGAS
State : NV
Zip : 89101-3702
Country : US
Telephone Number : 702-427-5307
Fax Number :
Provider Business Practice Location Address
First Line : 3020 E BONANZA RD
Second Line : BLDG D STE 160
City : LAS VEGAS
State : NV
Zip : 89101-3702
Country : US
Telephone Number : 702-427-5307
Fax Number :
Authorized Official
Title or Position : DIRECTOR
Name : MS. DENNYS BAUTISTA
Credential :
Telephone Number : 702-427-5307
Provider Enumeration Date : 02/16/2015
Last Update Date : 02/16/2015

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Directions to “GOLDEN AGES ADULT DAYCARE LLC ” Practice Location

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