Provider Demographics
NPI:1548437965
Name:SALVATION ARMY HENDERSON ADULT DAY CENTER
Entity type:Organization
Organization Name:SALVATION ARMY HENDERSON ADULT DAY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:DELOIS
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:BS, QMRP
Authorized Official - Phone:702-565-8836
Mailing Address - Street 1:830 E LAKE MEAD PKWY
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-5512
Mailing Address - Country:US
Mailing Address - Phone:702-565-8836
Mailing Address - Fax:702-558-8277
Practice Address - Street 1:830 E LAKE MEAD PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-5512
Practice Address - Country:US
Practice Address - Phone:702-565-8836
Practice Address - Fax:702-558-8277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV3902001Medicaid