Healthcare Provider Details

I. General information

NPI: 1376161653
Provider Name (Legal Business Name): DARIUS O MCCREE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2020
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4344 W CHEYENNE AVE
NORTH LAS VEGAS NV
89032-2484
US

IV. Provider business mailing address

4344 W CHEYENNE AVE
NORTH LAS VEGAS NV
89032-2484
US

V. Phone/Fax

Practice location:
  • Phone: 702-476-9697
  • Fax: 702-476-9697
Mailing address:
  • Phone: 702-476-9697
  • Fax: 702-476-9697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: