Healthcare Provider Details

I. General information

NPI: 1265074868
Provider Name (Legal Business Name): LIFECARE INFUSION INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2019
Last Update Date: 02/08/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6415 S FORT APACHE RD STE 175
LAS VEGAS NV
89148-6746
US

IV. Provider business mailing address

6415 S FORT APACHE RD STE 175
LAS VEGAS NV
89148-6746
US

V. Phone/Fax

Practice location:
  • Phone: 702-665-5730
  • Fax: 702-780-4887
Mailing address:
  • Phone: 702-330-0273
  • Fax: 702-780-4887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CLETUS AMADI
Title or Position: PRESIDENT/CEO/OWNER
Credential:
Phone: 702-303-6790