Provider Demographics
NPI:1982115911
Name:RENEWED MIND ADULT DAY CARE CENTER
Entity Type:Organization
Organization Name:RENEWED MIND ADULT DAY CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FAVOR
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIKELU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-772-3663
Mailing Address - Street 1:1311 S MARYLAND PKWY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-3309
Mailing Address - Country:US
Mailing Address - Phone:702-772-3663
Mailing Address - Fax:
Practice Address - Street 1:3211 N TENAYA WAY STE 110-112
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-7439
Practice Address - Country:US
Practice Address - Phone:702-772-3663
Practice Address - Fax:702-829-5426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-17
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care