Healthcare Provider Details

I. General information

NPI: 1154834984
Provider Name (Legal Business Name): I DECLARE HOMECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2017
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 S JONES BLVD
LAS VEGAS NV
89146-3103
US

IV. Provider business mailing address

2350 S JONES BLVD STE C3
LAS VEGAS NV
89146-3103
US

V. Phone/Fax

Practice location:
  • Phone: 702-214-2165
  • Fax: 702-214-5801
Mailing address:
  • Phone: 702-214-2165
  • Fax: 702-214-5801

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
# 3
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: MS. JANET HAZEL HILL
Title or Position: OWNER
Credential:
Phone: 702-504-4968