Healthcare Provider Details

I. General information

NPI: 1205183886
Provider Name (Legal Business Name): MY FAMILY HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2224 CANARY WAY
LAS VEGAS NV
89106-1912
US

IV. Provider business mailing address

2224 CANARY WAY
LAS VEGAS NV
89106-1912
US

V. Phone/Fax

Practice location:
  • Phone: 702-201-8585
  • Fax:
Mailing address:
  • Phone: 702-201-8585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. JEWEL DEGUZMAN
Title or Position: PRESIDENT
Credential: OWNER
Phone: 702-636-8762