Provider Demographics
NPI:1477052959
Name:LV ELITE CARE SERVICES LLC
Entity Type:Organization
Organization Name:LV ELITE CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTED
Authorized Official - Prefix:
Authorized Official - First Name:VENESA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-683-9747
Mailing Address - Street 1:7951 W CHARELSTON BLVD
Mailing Address - Street 2:#30
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117
Mailing Address - Country:US
Mailing Address - Phone:702-238-5949
Mailing Address - Fax:
Practice Address - Street 1:7951 W CHARELSTON BLVD
Practice Address - Street 2:#30
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117
Practice Address - Country:US
Practice Address - Phone:702-238-5949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-09
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20181100355251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVNV0001Medicaid