MEDICARE: GOLDEN CROSS HOME CARE, 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	253Z00000X	In Home Supportive Care Agency	NV20121287262	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386903599
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN CROSS HOME CARE, LLC.

Provider Business Mailing Address
First Line	:	417 WARMSIDE DR.
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89145
Country	:	US
Telephone Number	:	702-353-1542
Fax Number	:	702-258-1908

Provider Business Practice Location Address
First Line	:	7762 W SAHARA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-2700
Country	:	US
Telephone Number	:	702-353-1542
Fax Number	:	702-258-1908

Authorized Official
Title or Position	:	MANAGER / OWNER
Name	:	RAFFI A. POGOSYAN
Credential	:
Telephone Number	:	702-353-1542

Provider Enumeration Date	:	05/08/2012
Last Update Date	:	05/08/2012

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