Healthcare Provider Details

I. General information

NPI: 1376398073
Provider Name (Legal Business Name): DPSP HEALTH CARE WEST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2024
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9205 W RUSSELL RD STE 240
LAS VEGAS NV
89148-1425
US

IV. Provider business mailing address

9205 W RUSSELL RD STE 240
LAS VEGAS NV
89148-1425
US

V. Phone/Fax

Practice location:
  • Phone: 609-220-1184
  • Fax:
Mailing address:
  • Phone: 609-220-1184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. PAULA BOYD
Title or Position: OWNER
Credential:
Phone: 609-220-1184