Healthcare Provider Details

I. General information

NPI: 1720326689
Provider Name (Legal Business Name): EMMANUELLE'S IN-HOME CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2013
Last Update Date: 01/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1143 DEVON LAKE ST
LAS VEGAS NV
89110-2849
US

IV. Provider business mailing address

1143 DEVON LAKE ST
LAS VEGAS NV
89110-2849
US

V. Phone/Fax

Practice location:
  • Phone: 702-527-9088
  • Fax:
Mailing address:
  • Phone: 702-527-9088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number7251PCS-0
License Number StateNV

VIII. Authorized Official

Name: MRS. JOAN LOCSIN ANGAPAK
Title or Position: ADMINISTRATOR
Credential: CNA
Phone: 702-527-9088