Provider Demographics
NPI:1750685061
Name:DKS SERVICES
Entity Type:Organization
Organization Name:DKS SERVICES
Other - Org Name:SOUTHWEST HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:DUPRE'
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-823-1511
Mailing Address - Street 1:6280 S VALLEY VIEW BLVD
Mailing Address - Street 2:SUITE #522
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-3809
Mailing Address - Country:US
Mailing Address - Phone:702-823-1511
Mailing Address - Fax:702-823-1512
Practice Address - Street 1:6280 S VALLEY VIEW BLVD
Practice Address - Street 2:SUITE #522
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-3809
Practice Address - Country:US
Practice Address - Phone:702-823-1511
Practice Address - Fax:702-823-1512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5076HHA-5251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV297156Medicare PIN