Healthcare Provider Details

I. General information

NPI: 1104714468
Provider Name (Legal Business Name): AMBER DECACCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2025
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 N TAYLOR ST
FALLON NV
89406-5706
US

IV. Provider business mailing address

409 N TAYLOR ST
FALLON NV
89406-5706
US

V. Phone/Fax

Practice location:
  • Phone: 661-513-7905
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: