Healthcare Provider Details

I. General information

NPI: 1801706890
Provider Name (Legal Business Name): CLASSIC CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2685 S RAINBOW BLVD STE 209
LAS VEGAS NV
89146-5189
US

IV. Provider business mailing address

2685 S RAINBOW BLVD STE 209
LAS VEGAS NV
89146-5189
US

V. Phone/Fax

Practice location:
  • Phone: 702-342-9000
  • Fax: 702-315-5505
Mailing address:
  • Phone: 702-342-9000
  • Fax: 702-315-5505

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: MARYKNOLL TORRES
Title or Position: MANAGER
Credential:
Phone: 702-845-5934