Provider Demographics
NPI:1659818839
Name:VEGAS ADULT DAYCARE, INC
Entity Type:Organization
Organization Name:VEGAS ADULT DAYCARE, INC
Other - Org Name:VEGAS ADULT DAY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MYONG
Authorized Official - Middle Name:W
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-738-0514
Mailing Address - Street 1:1130 SHARON RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-2036
Mailing Address - Country:US
Mailing Address - Phone:702-738-0514
Mailing Address - Fax:702-527-7698
Practice Address - Street 1:1401 ARVILLE ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-0054
Practice Address - Country:US
Practice Address - Phone:702-738-0514
Practice Address - Fax:702-527-7698
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VEGAS ADULT DAY CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8408-ADC-1261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care