Provider Demographics
NPI:1841650231
Name:LAROCCA, JAMES
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:LAROCCA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 MOUNT EARL AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-5703
Mailing Address - Country:US
Mailing Address - Phone:702-327-9628
Mailing Address - Fax:
Practice Address - Street 1:172 MOUNT EARL AVE
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-5703
Practice Address - Country:US
Practice Address - Phone:702-327-9628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-29
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV88-6000022385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV9005038094OtherAPI NUMBER