Provider Demographics
NPI:1881654093
Name:GREATER VEGAS PERSONAL CARE
Entity Type:Organization
Organization Name:GREATER VEGAS PERSONAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FABIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALFARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-735-8884
Mailing Address - Street 1:336 S JONES BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-2623
Mailing Address - Country:US
Mailing Address - Phone:702-735-8884
Mailing Address - Fax:702-735-8886
Practice Address - Street 1:336 S JONES BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-2623
Practice Address - Country:US
Practice Address - Phone:702-735-8884
Practice Address - Fax:702-735-8886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV132986302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization