Healthcare Provider Details

I. General information

NPI: 1790958981
Provider Name (Legal Business Name): LAS VEGAS PERSONAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 09/03/2021
Certification Date: 09/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 ARVILLE ST STE 40
LAS VEGAS NV
89103-3811
US

IV. Provider business mailing address

4350 ARVILLE ST STE 200
LAS VEGAS NV
89103-3811
US

V. Phone/Fax

Practice location:
  • Phone: 702-202-3184
  • Fax: 702-202-3587
Mailing address:
  • Phone: 702-202-3184
  • Fax: 702-202-3587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number1005826609
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: YANISEL BENITEZ
Title or Position: MANAGER
Credential:
Phone: 702-972-2246