Provider Demographics
NPI:1740740927
Name:I DECLARE HOMECARE
Entity Type:Organization
Organization Name:I DECLARE HOMECARE
Other - Org Name:I DECLARE HOMECARE L.L.C
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:HAZEL
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-504-4968
Mailing Address - Street 1:2350 S JONES BLVD STE C3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-3103
Mailing Address - Country:US
Mailing Address - Phone:702-214-2165
Mailing Address - Fax:702-214-5801
Practice Address - Street 1:2350 S JONES BLVD STE C3
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-3103
Practice Address - Country:US
Practice Address - Phone:702-214-2165
Practice Address - Fax:702-214-5801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-22
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care