Healthcare Provider Details

I. General information

NPI: 1215856513
Provider Name (Legal Business Name): HAND IN HAND SUPPORTIVE CARE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5175 JERRY TARKANIAN WAY UNIT 20202
LAS VEGAS NV
89148-0014
US

IV. Provider business mailing address

5175 JERRY TARKANIAN WAY UNIT 20202
LAS VEGAS NV
89148-0014
US

V. Phone/Fax

Practice location:
  • Phone: 702-581-6651
  • 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

VIII. Authorized Official

Name: EBONY PETTY
Title or Position: OWNER/ ADMINISTRATOR
Credential:
Phone: 702-518-6651