Provider Demographics
NPI:1962791897
Name:ADULT DAY CARE OF LAS VEGAS
Entity type:Organization
Organization Name:ADULT DAY CARE OF LAS VEGAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DURAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-501-6072
Mailing Address - Street 1:953 E SAHARA AVE # A-7A8
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-3005
Mailing Address - Country:US
Mailing Address - Phone:702-501-6072
Mailing Address - Fax:702-734-2258
Practice Address - Street 1:953 E SAHARA AVE #A-7 A-8
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104
Practice Address - Country:US
Practice Address - Phone:702-501-6072
Practice Address - Fax:702-734-2258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6057ADC-0302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV=========Medicare PIN
NV=========Medicare Oscar/Certification