Provider Demographics
NPI:1043939861
Name:PERSONAL CARE NEVADA LLC
Entity Type:Organization
Organization Name:PERSONAL CARE NEVADA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:725-300-0104
Mailing Address - Street 1:6245 HARRISON DR STE 6
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-4035
Mailing Address - Country:US
Mailing Address - Phone:725-300-0104
Mailing Address - Fax:725-300-0446
Practice Address - Street 1:6245 HARRISON DR STE 6
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-4035
Practice Address - Country:US
Practice Address - Phone:725-300-0104
Practice Address - Fax:725-300-0446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care