Provider Demographics
NPI:1578046132
Name:VEGAS SENIOR HOME CARE LLC
Entity Type:Organization
Organization Name:VEGAS SENIOR HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MYONG
Authorized Official - Middle Name:WOOK
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-738-0514
Mailing Address - Street 1:1401 ARVILLE ST STE B
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-0537
Mailing Address - Country:US
Mailing Address - Phone:702-738-0844
Mailing Address - Fax:702-527-7698
Practice Address - Street 1:1130 SHARON RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-2036
Practice Address - Country:US
Practice Address - Phone:702-738-0514
Practice Address - Fax:702-527-7698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities