Provider Demographics
NPI:1407196777
Name:WWB INCORPORATED
Entity Type:Organization
Organization Name:WWB INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AREA MANAGER
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 1:2001 S. JONES BLVD
Mailing Address - Street 2:ADVANCED HOME HEALTH CARE SUITE. K
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-3165
Mailing Address - Country:US
Mailing Address - Phone:702-562-3355
Mailing Address - Fax:702-369-8284
Practice Address - Street 1:2860 E FLAMINGO RD
Practice Address - Street 2:SUITE. C
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5271
Practice Address - Country:US
Practice Address - Phone:702-562-3355
Practice Address - Fax:702-369-8284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5425PCS5253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV9005037013Medicaid
NV1245301464Medicaid