Healthcare Provider Details

I. General information

NPI: 1518422583
Provider Name (Legal Business Name): HOMEBASE HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2019
Last Update Date: 02/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3312 W CHARLESTON BLVD
LAS VEGAS NV
89102-1829
US

IV. Provider business mailing address

3312 W CHARLESTON BLVD
LAS VEGAS NV
89102-1829
US

V. Phone/Fax

Practice location:
  • Phone: 702-410-7825
  • Fax:
Mailing address:
  • Phone: 702-410-7825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: FRANCES MALINIS
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 702-410-7825