Provider Demographics
NPI:1720575251
Name:TANCELL CARE LLC
Entity Type:Organization
Organization Name:TANCELL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOUIE
Authorized Official - Middle Name:NOVELO
Authorized Official - Last Name:TANDIONO-CELLONA
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:702-882-4975
Mailing Address - Street 1:4000 S EASTERN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-0840
Mailing Address - Country:US
Mailing Address - Phone:702-476-0262
Mailing Address - Fax:
Practice Address - Street 1:9138 W RICHMAR AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89178-6228
Practice Address - Country:US
Practice Address - Phone:702-882-4975
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-19
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X
NV261QD1600X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities