| NPI | 1629548748 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VIRGINIA DURIAN LASAM Owner/Manager 702-476-1533 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2018-12-01 |
| Last Update Date | 2019-06-14 |