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NPI Code Detail

MEDICARE: COLONIAL HOME CARE

MEDICARE: COLONIAL HOME CARE
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
1251E00000XHome Health Agency524HHA-10NV

General Provider Information

NPI Number : 1780688234
Entity Type Code : Organization
Provider Name (Legal Business Name) : COLONIAL HOME CARE
Provider Business Mailing Address
First Line : 3530 E FLAMINGO RD
Second Line : STE 270
City : LAS VEGAS
State : NV
Zip : 89121-5092
Country : US
Telephone Number : 702-733-8533
Fax Number : 702-733-8498
Provider Business Practice Location Address
First Line : 3530 E FLAMINGO RD
Second Line : STE 270
City : LAS VEGAS
State : NV
Zip : 89121-5092
Country : US
Telephone Number : 702-733-8533
Fax Number : 702-733-8498
Authorized Official
Title or Position : BUSINESS MANAGER
Name : DARRIS CLARK
Credential : RN
Telephone Number : 702-733-8533
Provider Enumeration Date : 06/10/2005
Last Update Date : 08/22/2020

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Directions to “COLONIAL HOME CARE ” Practice Location

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