Healthcare Provider Details

I. General information

NPI: 1013337195
Provider Name (Legal Business Name): KAREN'S CAREGIVER HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2014
Last Update Date: 04/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5713 EUGENE AVE
LAS VEGAS NV
89108-6206
US

IV. Provider business mailing address

5713 EUGENE AVE
LAS VEGAS NV
89108-6206
US

V. Phone/Fax

Practice location:
  • Phone: 702-808-3581
  • Fax: 702-648-8910
Mailing address:
  • Phone: 702-808-3581
  • Fax: 702-648-8910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number3577HIC-12
License Number StateNV

VIII. Authorized Official

Name: MISS KAREN D. HUDSON
Title or Position: DIRECTOR
Credential:
Phone: 702-808-3581