Provider Demographics
NPI:1619391331
Name:RAY OF SUNSHINE ADULT DAY CARE
Entity Type:Organization
Organization Name:RAY OF SUNSHINE ADULT DAY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-357-7796
Mailing Address - Street 1:7720 W SAHARA AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-2799
Mailing Address - Country:US
Mailing Address - Phone:702-357-7796
Mailing Address - Fax:
Practice Address - Street 1:7720 W SAHARA AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2799
Practice Address - Country:US
Practice Address - Phone:702-357-7796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-17
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20111685065261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV=========Medicaid