Healthcare Provider Details

I. General information

NPI: 1104424134
Provider Name (Legal Business Name): MY JOY HOME CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2020
Last Update Date: 10/12/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3936 RUSKIN ST
LAS VEGAS NV
89147-6557
US

IV. Provider business mailing address

3936 RUSKIN ST
LAS VEGAS NV
89147-6557
US

V. Phone/Fax

Practice location:
  • Phone: 702-695-6432
  • Fax: 702-854-9711
Mailing address:
  • Phone: 702-695-6432
  • Fax: 702-854-9711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JUDI COOPER SMITH
Title or Position: CO-OWNER
Credential:
Phone: 702-695-6432