Provider Demographics
NPI:1689634024
Name:MINI-CARE SERVICES OF LAS VEGAS
Entity Type:Organization
Organization Name:MINI-CARE SERVICES OF LAS VEGAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHARLEEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:WINTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-368-2411
Mailing Address - Street 1:3300 SIRIUS AVE
Mailing Address - Street 2:108
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-7821
Mailing Address - Country:US
Mailing Address - Phone:702-368-2411
Mailing Address - Fax:702-873-1581
Practice Address - Street 1:3300 SIRIUS AVE
Practice Address - Street 2:108
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-7821
Practice Address - Country:US
Practice Address - Phone:702-368-2411
Practice Address - Fax:702-873-1581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV65225251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health