Provider Demographics
NPI:1124573969
Name:IMMEDIATE PERSONAL CARE INC
Entity Type:Organization
Organization Name:IMMEDIATE PERSONAL CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OGBOUMA
Authorized Official - Middle Name:OKE
Authorized Official - Last Name:ULOFOSHIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-529-1572
Mailing Address - Street 1:2820 W CHARLESTON BLVD STE 8
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1929
Mailing Address - Country:US
Mailing Address - Phone:702-586-7431
Mailing Address - Fax:702-586-7260
Practice Address - Street 1:2820 W. CHARLESTON BLVD SUITE 8
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102
Practice Address - Country:US
Practice Address - Phone:702-586-7431
Practice Address - Fax:702-586-7260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-22
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV8227PCO0Medicaid