Healthcare Provider Details

I. General information

NPI: 1184169807
Provider Name (Legal Business Name): PREFERRED HOMECARE INFUSION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2017
Last Update Date: 08/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

871 GRIER DR STE B2
LAS VEGAS NV
89119
US

IV. Provider business mailing address

PO BOX 40700
MESA AZ
85274-0700
US

V. Phone/Fax

Practice location:
  • Phone: 702-214-8899
  • Fax: 702-214-2621
Mailing address:
  • Phone: 480-446-9010
  • Fax: 480-993-2033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM KEYS
Title or Position: CEO
Credential:
Phone: 480-446-9010