Healthcare Provider Details

I. General information

NPI: 1013555135
Provider Name (Legal Business Name): PURITY HOME HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2019
Last Update Date: 05/11/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3460 E SUNSET RD STE K-104
LAS VEGAS NV
89120-3355
US

IV. Provider business mailing address

3460 E SUNSET RD STE K-104
LAS VEGAS NV
89120-3355
US

V. Phone/Fax

Practice location:
  • Phone: 646-418-4681
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MAWATA FOFANA
Title or Position: OWNER PRESIDENT
Credential:
Phone: 646-418-4681