Provider Demographics
NPI:1457447591
Name:VEGAS VALLEY PERSONAL CARE
Entity Type:Organization
Organization Name:VEGAS VALLEY PERSONAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:EMA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMEZ -MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-870-8855
Mailing Address - Street 1:5016 ALTA DR
Mailing Address - Street 2:SUITE # 1
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-3944
Mailing Address - Country:US
Mailing Address - Phone:702-870-8855
Mailing Address - Fax:702-870-8857
Practice Address - Street 1:5016 ALTA DR
Practice Address - Street 2:SUITE # 1
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-3944
Practice Address - Country:US
Practice Address - Phone:702-870-8855
Practice Address - Fax:702-870-8857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVH1400141B120899302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization