Provider Demographics
NPI:1073759437
Name:ADDIE'S HOME CARE INC
Entity Type:Organization
Organization Name:ADDIE'S HOME CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ADDIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DEGUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-227-1522
Mailing Address - Street 1:7955 TRAIL HEAD DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-1706
Mailing Address - Country:US
Mailing Address - Phone:702-227-1522
Mailing Address - Fax:702-685-8686
Practice Address - Street 1:7955 TRAIL HEAD DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-1706
Practice Address - Country:US
Practice Address - Phone:702-227-1522
Practice Address - Fax:702-685-8686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5303AGC177F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes177F00000XOther Service ProvidersLodgingGroup - Single Specialty