Healthcare Provider Details

I. General information

NPI: 1801247952
Provider Name (Legal Business Name): FAMILY PERSONAL CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2016
Last Update Date: 06/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4550 W OAKEY BLVD STE 108A
LAS VEGAS NV
89102-1506
US

IV. Provider business mailing address

4550 W OAKEY BLVD STE 108A
LAS VEGAS NV
89102-1506
US

V. Phone/Fax

Practice location:
  • Phone: 702-906-1999
  • Fax:
Mailing address:
  • Phone: 702-906-1999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number8062PCS3
License Number StateNV

VIII. Authorized Official

Name: JUAN A AVILA
Title or Position: MANAGER
Credential:
Phone: 702-906-1999