Provider Demographics
NPI:1992550263
Name:M AND DC, LLC
Entity type:Organization
Organization Name:M AND DC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANLICLIC-DELA CUESTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-882-9776
Mailing Address - Street 1:2757 GALLANT HILLS DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-1757
Mailing Address - Country:US
Mailing Address - Phone:702-882-9776
Mailing Address - Fax:702-995-0676
Practice Address - Street 1:2757 GALLANT HILLS DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89135-1757
Practice Address - Country:US
Practice Address - Phone:702-882-9776
Practice Address - Fax:702-995-0676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-20
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)