Healthcare Provider Details

I. General information

NPI: 1386439131
Provider Name (Legal Business Name): HEALTHY LIFE PERSONAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2025
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6655 W SAHARA AVE # B200-126
LAS VEGAS NV
89146-0842
US

IV. Provider business mailing address

6655 W SAHARA AVE # B200-126
LAS VEGAS NV
89146-0842
US

V. Phone/Fax

Practice location:
  • Phone: 725-204-1611
  • Fax: 725-204-5133
Mailing address:
  • Phone: 725-204-1611
  • Fax: 725-204-5133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: MRS. CINDY MELARA GOMEZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 725-204-1611