Healthcare Provider Details

I. General information

NPI: 1578046132
Provider Name (Legal Business Name): VEGAS SENIOR HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2018
Last Update Date: 09/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 SHARON RD
LAS VEGAS NV
89106-2036
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 702-738-0514
  • Fax: 702-527-7698
Mailing address:
  • Phone: 702-738-0844
  • Fax: 702-527-7698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. MYONG WOOK KIM
Title or Position: OWNER
Credential:
Phone: 702-738-0514