MEDICARE: VENUS SENIOR 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
1	261QA0600X	Adult Day Care Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12345	OTHER	CA	MANAGED CARE ORGANIZATIONS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891294328
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VENUS SENIOR LLC

Provider Business Mailing Address
First Line	:	35145 NEWARK BLVD
Second Line	:
City	:	NEWARK
State	:	CA
Zip	:	94560-1219
Country	:	US
Telephone Number	:	510-791-2492
Fax Number	:	510-494-1525

Provider Business Practice Location Address
First Line	:	35145 NEWARK BLVD
Second Line	:
City	:	NEWARK
State	:	CA
Zip	:	94560-1219
Country	:	US
Telephone Number	:	510-791-2492
Fax Number	:	510-494-1525

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MISS MAYANK PATEL
Credential	:
Telephone Number	:	510-648-8254

Provider Enumeration Date	:	02/10/2018
Last Update Date	:	02/10/2018

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Directions to “VENUS SENIOR LLC ” Practice Location

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