Provider Demographics
NPI:1447802574
Name:IDEAL CARE HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:IDEAL CARE HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RAYMUND
Authorized Official - Middle Name:MORA
Authorized Official - Last Name:LONTOC
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:702-331-1426
Mailing Address - Street 1:1641 E FLAMINGO RD STE 13
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5257
Mailing Address - Country:US
Mailing Address - Phone:702-331-1426
Mailing Address - Fax:702-331-4756
Practice Address - Street 1:1641 E FLAMINGO RD STE 13
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5257
Practice Address - Country:US
Practice Address - Phone:702-331-1426
Practice Address - Fax:702-331-4756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-09
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVNV20181363119OtherNEVADA STATE BUSINESS LICENSE