Healthcare Provider Details

I. General information

NPI: 1740641984
Provider Name (Legal Business Name): 702 CAREGIVERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2016
Last Update Date: 08/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2780 S JONES BLVD STE 105B
LAS VEGAS NV
89146
US

IV. Provider business mailing address

2780 S JONES BLVD STE 105B
LAS VEGAS NV
89146-5625
US

V. Phone/Fax

Practice location:
  • Phone: 702-333-1488
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DMITRIY SHUKAN
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 702-333-1488