Provider Demographics
NPI:1598156267
Name:GOLDEN AGES ADULT DAYCARE LLC
Entity Type:Organization
Organization Name:GOLDEN AGES ADULT DAYCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DENNYS
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUTISTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-427-5307
Mailing Address - Street 1:3020 E BONANZA RD
Mailing Address - Street 2:BLDG D STE 160
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-3702
Mailing Address - Country:US
Mailing Address - Phone:702-427-5307
Mailing Address - Fax:
Practice Address - Street 1:3020 E BONANZA RD
Practice Address - Street 2:BLDG D STE 160
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-3702
Practice Address - Country:US
Practice Address - Phone:702-427-5307
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8122ADC-0261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care