Healthcare Provider Details

I. General information

NPI: 1275098758
Provider Name (Legal Business Name): DD PERSONAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2019
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 S EASTERN AVE STE A
LAS VEGAS NV
89104-4109
US

IV. Provider business mailing address

PO BOX 43753
LAS VEGAS NV
89116-1753
US

V. Phone/Fax

Practice location:
  • Phone: 702-207-0842
  • Fax: 702-207-0357
Mailing address:
  • Phone: 702-207-0842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ADINUBIA VEGA
Title or Position: ADMINISTRATOR
Credential:
Phone: 702-207-0842