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General NPI Number Information
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NPI Number | 1104465434
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Entity Type | Organization
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Legal Business Name | CCI HOME CARE, LLC
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Dates
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Enumeration Date | 01/03/2020
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Last Update Date | 01/03/2020
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Provider Practice Location Address
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Address Line | 500 N RAINBOW BLVD STE 300-318
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City | LAS VEGAS
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State | NV
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Zip | 89107-1082
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Country | US
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Telephone | 702-333-8153
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Fax |
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Provider Business Mailing Address
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Address Line | 5263 SOUVENIR LN
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City | LAS VEGAS
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State | NV
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Zip | 89118-1334
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Country | US
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Telephone | 725-400-3592
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Fax | 702-333-0662
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MINYON SHARPE
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Credential | LPN
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Telephone | 725-400-3592
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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