Healthcare Provider Details

I. General information

NPI: 1770028706
Provider Name (Legal Business Name): SENIOR SERVICES PERSONAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2016
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 S JONES BLVD SUITE B
LAS VEGAS NV
89107-2623
US

IV. Provider business mailing address

336 S JONES BLVD SUITE B
LAS VEGAS NV
89107-2623
US

V. Phone/Fax

Practice location:
  • Phone: 702-953-7910
  • Fax: 702-953-2250
Mailing address:
  • Phone: 702-953-7910
  • Fax: 702-953-2250

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 Code385H00000X
TaxonomyRespite Care
License Number8627-PCS-0
License Number StateNV

VIII. Authorized Official

Name: ANGEL SALVADOR CARRILLO
Title or Position: MANAGER
Credential:
Phone: 702-953-7910