Healthcare Provider Details

I. General information

NPI: 1235454521
Provider Name (Legal Business Name): AT HOME CAREGIVERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2010
Last Update Date: 08/08/2022
Certification Date: 08/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3017 W CHARLESTON BLVD STE 12
LAS VEGAS NV
89102-1927
US

IV. Provider business mailing address

3017 W CHARLESTON BLVD STE 12
LAS VEGAS NV
89102-1927
US

V. Phone/Fax

Practice location:
  • Phone: 702-240-3800
  • Fax: 702-240-3001
Mailing address:
  • Phone: 702-240-3800
  • Fax: 702-240-3001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number5267PCS
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MRS. FLORDELIZA C. ANTOLIK
Title or Position: ADMINISTRATOR
Credential:
Phone: 702-240-3800