MEDICARE: NEVADA PCA, 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		NV

General Provider Information

NPI Number	:	1598135543
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEVADA PCA, LLC.

Provider Business Mailing Address
First Line	:	332 S DECATUR BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-2804
Country	:	US
Telephone Number	:	702-665-5654
Fax Number	:	702-665-5838

Provider Business Practice Location Address
First Line	:	332 S DECATUR BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-2804
Country	:	US
Telephone Number	:	702-665-5654
Fax Number	:	702-665-5838

Authorized Official
Title or Position	:	OWNER
Name	:	EDGAR JIMENEZ
Credential	:
Telephone Number	:	702-273-6658

Provider Enumeration Date	:	10/03/2015
Last Update Date	:	02/20/2019

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