Provider Demographics
NPI:1154492320
Name:PTV1, INC.
Entity Type:Organization
Organization Name:PTV1, INC.
Other - Org Name:HOME HEALTH CARE SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-273-6658
Mailing Address - Street 1:70 E HORIZON RIDGE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89002-7936
Mailing Address - Country:US
Mailing Address - Phone:702-644-3600
Mailing Address - Fax:702-719-5665
Practice Address - Street 1:70 E HORIZON RIDGE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89002-7936
Practice Address - Country:US
Practice Address - Phone:702-644-3600
Practice Address - Fax:702-719-5665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100502021Medicaid