Healthcare Provider Details

I. General information

NPI: 1801773924
Provider Name (Legal Business Name): MAMA HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2025
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 ARVILLE ST STE G
LAS VEGAS NV
89102-0537
US

IV. Provider business mailing address

1401 ARVILLE ST STE G
LAS VEGAS NV
89102-0537
US

V. Phone/Fax

Practice location:
  • Phone: 702-738-0515
  • Fax: 702-527-7698
Mailing address:
  • Phone: 702-738-0515
  • Fax: 702-527-7698

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: ALEXIS DAVID KIM
Title or Position: ADMINISTRATOR
Credential:
Phone: 702-738-0515