MEDICARE: RESPECT LOVE & DEDICATION 2 LLCDE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1093205361
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESPECT LOVE & DEDICATION 2 LLCDE

Provider Business Mailing Address
First Line	:	1600 E SAINT LOUIS AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-3554
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 E SAINT LOUIS AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-3554
Country	:	US
Telephone Number	:	702-980-6159
Fax Number	:

Authorized Official
Title or Position	:	SECRETARY
Name	:	DEVON SIMMS-JOHNSON
Credential	:
Telephone Number	:	702-980-6159

Provider Enumeration Date	:	05/13/2018
Last Update Date	:	05/13/2018

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Directions to “RESPECT LOVE & DEDICATION 2 LLCDE ” Practice Location

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