Provider Demographics
NPI:1013519073
Name:PLAXIA CARE LLC
Entity Type:Organization
Organization Name:PLAXIA CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CROCK
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:702-858-4559
Mailing Address - Street 1:4565 N CHIEFTAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-2608
Mailing Address - Country:US
Mailing Address - Phone:702-858-4559
Mailing Address - Fax:810-885-0572
Practice Address - Street 1:5095 N PARK ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-2522
Practice Address - Country:US
Practice Address - Phone:702-858-4559
Practice Address - Fax:810-885-0572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVNV20191673366OtherSECRETARY OF STATE
NV10219-AGC-0OtherHEALTH AND HUMAN SERVICES DIVISION OF PUBIC AND BEHAVIORAL HEALTH