Healthcare Provider Details

I. General information

NPI: 1386148195
Provider Name (Legal Business Name): LGCM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 03/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 E HORIZON RIDGE PKWY STE 140
HENDERSON NV
89002-7936
US

IV. Provider business mailing address

70 E HORIZON RIDGE PKWY STE 140
HENDERSON NV
89002-7936
US

V. Phone/Fax

Practice location:
  • Phone: 702-750-0475
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CLARE-LANIE MACARAEG
Title or Position: OWNER
Credential:
Phone: 702-750-0475