Provider Demographics
NPI:1629735683
Name:SANTA MARIA ADULT DAY HEALTHCARE LLC
Entity Type:Organization
Organization Name:SANTA MARIA ADULT DAY HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LORENZO
Authorized Official - Middle Name:
Authorized Official - Last Name:TAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:860-977-3215
Mailing Address - Street 1:625 N LAMB BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-6355
Mailing Address - Country:US
Mailing Address - Phone:725-780-1104
Mailing Address - Fax:
Practice Address - Street 1:625 N LAMB BLVD STE 140
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-6355
Practice Address - Country:US
Practice Address - Phone:725-780-1104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV00000000Medicaid