Healthcare Provider Details

I. General information

NPI: 1912854589
Provider Name (Legal Business Name): SAFE SPACE HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2026
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5236 MARSH BUTTE ST
LAS VEGAS NV
89148-1624
US

IV. Provider business mailing address

5236 MARSH BUTTE ST
LAS VEGAS NV
89148-1624
US

V. Phone/Fax

Practice location:
  • Phone: 702-847-9295
  • Fax:
Mailing address:
  • Phone: 702-847-9295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
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 TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: ANTOINETTE CHAVON MINOR
Title or Position: OWNER/ ADMINISTRATOR
Credential:
Phone: 702-847-9295