Provider Demographics
NPI:1083367809
Name:LAS VEGAS FAMILY HOME CARE LLC
Entity Type:Organization
Organization Name:LAS VEGAS FAMILY HOME CARE LLC
Other - Org Name:HCBS WAIVER FOR PERSONS WITH PHYSICAL DISABILITIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINITRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MAIDELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LA PAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-769-0584
Mailing Address - Street 1:1650 E SAHARA AVE STE 4A
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-3495
Mailing Address - Country:US
Mailing Address - Phone:702-769-0584
Mailing Address - Fax:
Practice Address - Street 1:1650 E SAHARA AVE STE 4A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-3495
Practice Address - Country:US
Practice Address - Phone:702-769-0584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAS VEGAS FAMILY HOME CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-01
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty