Provider Demographics
NPI:1790958981
Name:LAS VEGAS PERSONAL CARE
Entity Type:Organization
Organization Name:LAS VEGAS PERSONAL CARE
Other - Org Name:LAS VEGAS HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YANISEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BENITEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-972-2246
Mailing Address - Street 1:4350 ARVILLE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-3811
Mailing Address - Country:US
Mailing Address - Phone:702-202-3184
Mailing Address - Fax:702-202-3587
Practice Address - Street 1:4350 ARVILLE ST STE 40
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-3811
Practice Address - Country:US
Practice Address - Phone:702-202-3184
Practice Address - Fax:702-202-3587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1005826609302F00000X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No302F00000XManaged Care OrganizationsExclusive Provider OrganizationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1790958981Medicaid