Healthcare Provider Details

I. General information

NPI: 1417359738
Provider Name (Legal Business Name): CPR247
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2014
Last Update Date: 09/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 E SUNSET RD 5-568
LAS VEGAS NV
89120-3511
US

IV. Provider business mailing address

2510 E SUNSET RD 5-568
LAS VEGAS NV
89120-3511
US

V. Phone/Fax

Practice location:
  • Phone: 702-619-6666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care 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 Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: AMANDA YAMAUCHI
Title or Position: CEO
Credential:
Phone: 702-619-6666