Provider Demographics
NPI:1336850361
Name:PEARL CARE HOME LLC
Entity Type:Organization
Organization Name:PEARL CARE HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER / MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:DEGUZMAN
Authorized Official - Last Name:DESAMITO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-807-9971
Mailing Address - Street 1:1012 PARADISE VIEW ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-3937
Mailing Address - Country:US
Mailing Address - Phone:702-614-7059
Mailing Address - Fax:702-614-1247
Practice Address - Street 1:1012 PARADISE VIEW ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3937
Practice Address - Country:US
Practice Address - Phone:702-614-7059
Practice Address - Fax:702-614-1247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home