Provider Demographics
NPI:1801215033
Name:CARE GOLD, LLC
Entity Type:Organization
Organization Name:CARE GOLD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAMATCHI
Authorized Official - Middle Name:
Authorized Official - Last Name:ANBAZHAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-781-0868
Mailing Address - Street 1:3650 S DECATUR BLVD
Mailing Address - Street 2:#23
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-5864
Mailing Address - Country:US
Mailing Address - Phone:702-781-0868
Mailing Address - Fax:866-529-1497
Practice Address - Street 1:3650 S DECATUR BLVD
Practice Address - Street 2:#23
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-5864
Practice Address - Country:US
Practice Address - Phone:702-781-0868
Practice Address - Fax:866-529-1497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-15
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV13978261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV13978OtherNV