1285294850 NPI number — QUALITY OF LIFE ADULT DAY CARE LLC

Table of content: (NPI 1285294850)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285294850 NPI number — QUALITY OF LIFE ADULT DAY CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QUALITY OF LIFE ADULT DAY CARE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285294850
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5900 W CHARLESTON BLVD STE 8
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89146-1143
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-333-1470
Provider Business Mailing Address Fax Number:
702-822-6100

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5900 W CHARLESTON BLVD STE 8
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89146-1143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-333-1470
Provider Business Practice Location Address Fax Number:
702-822-6100
Provider Enumeration Date:
06/17/2019

Additional Information

Authorized Official

Authorized Official Last Name:
CARRILLO
Authorized Official First Name:
HECTOR
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
702-333-1470

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9047-ADC-0 . This is a "DEPARTMENT OF PUBLIC AND BEHAVIORAL HEALTH" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com