Provider Demographics
NPI:1417594284
Name:DANIEL ALEXANDER LLC
Entity Type:Organization
Organization Name:DANIEL ALEXANDER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER / FACILITY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:DEGUZMAN
Authorized Official - Last Name:DESAMITO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-897-0925
Mailing Address - Street 1:508 PEARBERRY AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-7219
Mailing Address - Country:US
Mailing Address - Phone:702-897-0925
Mailing Address - Fax:702-897-0926
Practice Address - Street 1:508 PEARBERRY AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89183-7219
Practice Address - Country:US
Practice Address - Phone:702-897-0925
Practice Address - Fax:702-897-0926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-29
Last Update Date:2019-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV9793-AGCOtherNV DEPT HEALTH & HUMAN SERVICES / DIV OF PUBLIC & BEHAVIORAL HEALTH