Healthcare Provider Details

I. General information

NPI: 1851994560
Provider Name (Legal Business Name): PRECIOUS HEARTS HEALTH CARE PROVIDERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2020
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6671 LAS VEGAS BLVD S UNIT 210
LAS VEGAS NV
89119-3289
US

IV. Provider business mailing address

6671 LAS VEGAS BLVD S UNIT 210
LAS VEGAS NV
89119-3289
US

V. Phone/Fax

Practice location:
  • Phone: 702-473-5897
  • Fax: 702-463-3137
Mailing address:
  • Phone: 702-473-5897
  • Fax: 702-463-3173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: RAUL GOMEZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 702-473-5897