Provider Demographics
NPI:1528427614
Name:INTERNATIONAL ADULT DAY CARE
Entity type:Organization
Organization Name:INTERNATIONAL ADULT DAY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING/BILLING
Authorized Official - Prefix:MRS
Authorized Official - First Name:DELIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:702-258-4900
Mailing Address - Street 1:2215 RENAISSANCE DR
Mailing Address - Street 2:STE A
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6163
Mailing Address - Country:US
Mailing Address - Phone:702-405-6393
Mailing Address - Fax:702-405-6564
Practice Address - Street 1:2215 RENAISSANCE DR
Practice Address - Street 2:STE A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6163
Practice Address - Country:US
Practice Address - Phone:702-405-6393
Practice Address - Fax:702-405-6564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-17
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2014159531261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1972792075Medicaid
NV1477632685Medicaid
NV1972792075Medicaid
NVV112546Medicare PIN