Provider Demographics
NPI:1841651551
Name:VEGAS COMPASSIONATE CARE LLC
Entity type:Organization
Organization Name:VEGAS COMPASSIONATE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:MIUSSKA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMEJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-413-6011
Mailing Address - Street 1:2820 W CHARLESTON BLVD STE B-21
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1942
Mailing Address - Country:US
Mailing Address - Phone:702-413-6011
Mailing Address - Fax:702-988-8780
Practice Address - Street 1:2820 W CHARLESTON BLVD STE B-21
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1942
Practice Address - Country:US
Practice Address - Phone:702-413-6011
Practice Address - Fax:702-988-8780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-09
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1528424348Medicaid