Provider Demographics
NPI:1588020838
Name:PROFESSIONAL IN-HOME CARE AGENCY
Entity type:Organization
Organization Name:PROFESSIONAL IN-HOME CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MERLA
Authorized Official - Middle Name:
Authorized Official - Last Name:PELAYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-586-2891
Mailing Address - Street 1:739 CAMINO DEL RAY
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-2610
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:739 CAMINO DEL RAY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-2610
Practice Address - Country:US
Practice Address - Phone:702-586-2891
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-31
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7922PCS-0251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health