Provider Demographics
NPI:1710058573
Name:ABSOLUTE HOME CARE INC.
Entity Type:Organization
Organization Name:ABSOLUTE HOME CARE INC.
Other - Org Name:ABSOLUTE HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:VALENTIN
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-318-5005
Mailing Address - Street 1:2860 E FLAMINGO RD SUITE K
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121
Mailing Address - Country:US
Mailing Address - Phone:702-318-5005
Mailing Address - Fax:702-318-5006
Practice Address - Street 1:2860 E FLAMINGO RD STE K
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5270
Practice Address - Country:US
Practice Address - Phone:702-318-5005
Practice Address - Fax:702-318-5006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2017-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV20031450181253Z00000X
302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1710058573Medicaid
NV100500935Medicaid