Provider Demographics
NPI:1871246850
Name:ST. AGATHA COMFORT CARE LLC
Entity Type:Organization
Organization Name:ST. AGATHA COMFORT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DESIGNEE/ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ARIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AVILA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:702-413-7285
Mailing Address - Street 1:11145 S EASTERN AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4392
Mailing Address - Country:US
Mailing Address - Phone:702-413-7285
Mailing Address - Fax:702-413-7284
Practice Address - Street 1:11145 S EASTERN AVE STE 140
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4392
Practice Address - Country:US
Practice Address - Phone:702-413-7285
Practice Address - Fax:702-413-7284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH1000XNursing Service ProvidersRegistered NurseHospiceGroup - Multi-Specialty