Healthcare Provider Details

I. General information

NPI: 1215472055
Provider Name (Legal Business Name): HEALTH AND CARE PROFESSIONAL NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

4850 W FLAMINGO RD 25
LAS VEGAS NV
89103-3705
US

IV. Provider business mailing address

4850 W FLAMINGO RD 25
LAS VEGAS NV
89103-3705
US

V. Phone/Fax

Practice location:
  • Phone: 702-871-9917
  • Fax: 702-871-9918
Mailing address:
  • Phone: 702-871-9917
  • Fax: 702-871-9918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number7872PCS-0
License Number StateNV

VIII. Authorized Official

Name: MS. GEMMA VIRAY
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 702-871-9917