Healthcare Provider Details

I. General information

NPI: 1427578418
Provider Name (Legal Business Name): EMPRES PERSONAL CARE NEVADA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 06/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 MOUNTAIN ST
CARSON CITY NV
89703-3819
US

IV. Provider business mailing address

4601 NE 77TH AVE STE 300
VANCOUVER WA
98662-6736
US

V. Phone/Fax

Practice location:
  • Phone: 775-392-2000
  • Fax:
Mailing address:
  • Phone: 360-892-6628
  • Fax: 360-882-5793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number7175-PCS-8
License Number StateNV

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: BRENT WEIL
Title or Position: CEO AND MANAGER
Credential:
Phone: 360-892-6628