Provider Demographics
NPI:1376308007
Name:EXPRESS HOME CARE LLC
Entity Type:Organization
Organization Name:EXPRESS HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SHANEL
Authorized Official - Middle Name:MACALINO
Authorized Official - Last Name:MERCADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-517-0449
Mailing Address - Street 1:8987 W FLAMINGO ROAD
Mailing Address - Street 2:#105 SUITE S104
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147
Mailing Address - Country:US
Mailing Address - Phone:725-777-6764
Mailing Address - Fax:973-860-4339
Practice Address - Street 1:8987 W FLAMINGO ROAD
Practice Address - Street 2:#105 SUITE S104
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147
Practice Address - Country:US
Practice Address - Phone:725-777-6764
Practice Address - Fax:973-860-4339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-21
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty