Provider Demographics
NPI:1033606801
Name:WHOLE LIFE PERSONAL CARE AGENCY
Entity Type:Organization
Organization Name:WHOLE LIFE PERSONAL CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:M
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:702-412-5175
Mailing Address - Street 1:2525 N DECATUR BLVD STE 2AND5
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-2975
Mailing Address - Country:US
Mailing Address - Phone:702-982-3636
Mailing Address - Fax:702-982-3737
Practice Address - Street 1:2525 N DECATUR BLVD STE 2AND5
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-2975
Practice Address - Country:US
Practice Address - Phone:702-982-3636
Practice Address - Fax:702-982-3737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV201801659566253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care