Provider Demographics
NPI:1205381522
Name:FAMILY PERSONAL CARE, LLC
Entity Type:Organization
Organization Name:FAMILY PERSONAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:AVILA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-906-1999
Mailing Address - Street 1:4550 W OAKEY BLVD STE 108A
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1506
Mailing Address - Country:US
Mailing Address - Phone:702-906-1999
Mailing Address - Fax:
Practice Address - Street 1:4550 W OAKEY BLVD STE 108A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1506
Practice Address - Country:US
Practice Address - Phone:702-906-1999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8062PCS3251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1801247952OtherNPPES
NV1861806408OtherNPPES