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General NPI Number Information
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NPI Number | 1013555135
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Entity Type | Organization
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Legal Business Name | PURITY HOME HEALTHCARE SERVICES
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Dates
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Enumeration Date | 12/19/2019
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Last Update Date | 05/11/2021
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Provider Practice Location Address
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Address Line | 3460 E SUNSET RD STE K-104
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City | LAS VEGAS
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State | NV
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Zip | 89120-3355
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Country | US
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Telephone | 646-418-4681
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Fax |
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Provider Business Mailing Address
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Address Line | 3460 E SUNSET RD STE K-104
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City | LAS VEGAS
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State | NV
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Zip | 89120-3355
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | MAWATA FOFANA
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Credential |
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Telephone | 646-418-4681
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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