MEDICARE: CARE WITH PURPOSE MEDICAL CENTER, LLC

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	261QP3300X	Pain Clinic/Center
2	208D00000X	General Practice Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	APRN002399	OTHER	NV	PHYSICIAN ASSISTANTS & ADVANCED PRACTICE NURSING PROVIDERS / NURSE PRACTITIONER

General Provider Information

NPI Number	:	1164049375
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARE WITH PURPOSE MEDICAL CENTER, LLC

Provider Business Mailing Address
First Line	:	2580 N RANCHO DR STE 103
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-3361
Country	:	US
Telephone Number	:	818-481-3571
Fax Number	:

Provider Business Practice Location Address
First Line	:	2580 N RANCHO DR STE 103
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-3361
Country	:	US
Telephone Number	:	818-481-3571
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHENAKWA HAWKINS
Credential	:	RN
Telephone Number	:	818-481-3571

Provider Enumeration Date	:	07/03/2020
Last Update Date	:	07/03/2020

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Directions to “CARE WITH PURPOSE MEDICAL CENTER, LLC ” Practice Location

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