Provider Demographics
NPI:1598135543
Name:NEVADA PCA, LLC.
Entity Type:Organization
Organization Name:NEVADA PCA, LLC.
Other - Org Name:NEVADA PCA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-273-6658
Mailing Address - Street 1:332 S DECATUR BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-2804
Mailing Address - Country:US
Mailing Address - Phone:702-665-5654
Mailing Address - Fax:702-665-5838
Practice Address - Street 1:332 S DECATUR BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-2804
Practice Address - Country:US
Practice Address - Phone:702-665-5654
Practice Address - Fax:702-665-5838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-03
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care