Healthcare Provider Details

I. General information

NPI: 1386903763
Provider Name (Legal Business Name): NEVADA PERSONAL CARE SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2012
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6615 S EASTERN AVE STE 104
LAS VEGAS NV
89119
US

IV. Provider business mailing address

PO BOX 211706
ANCHORAGE AK
99521-1706
US

V. Phone/Fax

Practice location:
  • Phone: 907-727-4090
  • Fax: 702-722-6202
Mailing address:
  • Phone: 907-727-4090
  • Fax: 907-337-2079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number7417PCO-5
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: GANIYU SHITTU
Title or Position: PRESIDENT
Credential:
Phone: 907-727-4090