Healthcare Provider Details

I. General information

NPI: 1013460278
Provider Name (Legal Business Name): SYB, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2016
Last Update Date: 07/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 N TOWN CENTER DR SUITE #100
LAS VEGAS NV
89144-6363
US

IV. Provider business mailing address

3058 EMERALD WIND ST
HENDERSON NV
89052-3098
US

V. Phone/Fax

Practice location:
  • Phone: 702-800-4616
  • Fax:
Mailing address:
  • Phone: 702-237-1611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number8587-PCS-0
License Number StateNV

VIII. Authorized Official

Name: MR. ROBERT EDWARD SWADKINS
Title or Position: OWNER
Credential:
Phone: 702-237-1611