Provider Demographics
NPI:1770280505
Name:AGED LIVING FACILITY
Entity type:Organization
Organization Name:AGED LIVING FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINH
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-275-2789
Mailing Address - Street 1:7754 WHITESBORO CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-5794
Mailing Address - Country:US
Mailing Address - Phone:254-275-2789
Mailing Address - Fax:866-776-8014
Practice Address - Street 1:7754 WHITESBORO CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89139-5794
Practice Address - Country:US
Practice Address - Phone:254-275-2789
Practice Address - Fax:866-776-8014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No385H00000XRespite Care FacilityRespite Care