Provider Demographics
NPI:1134745722
Name:1STAID CARE LLC
Entity type:Organization
Organization Name:1STAID CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KIDIAVAYI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-761-6457
Mailing Address - Street 1:7455 ARROYO CROSSING PKWY STE 220
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-4088
Mailing Address - Country:US
Mailing Address - Phone:702-761-6457
Mailing Address - Fax:
Practice Address - Street 1:7455 ARROYO CROSSING PKWY STE 220
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-4088
Practice Address - Country:US
Practice Address - Phone:702-761-6457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty