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General NPI Number Information
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NPI Number | 1124832779
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Entity Type | Organization
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Legal Business Name | I DECLARE HOME
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Dates
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Enumeration Date | 02/04/2025
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Last Update Date | 02/04/2025
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Provider Practice Location Address
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Address Line | 6125 W SAHARA AVE
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City | LAS VEGAS
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State | NV
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Zip | 89146-3037
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Country | US
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Telephone | 702-248-0554
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Fax |
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Provider Business Mailing Address
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Address Line | 809 W ADAMS AVE
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City | LAS VEGAS
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State | NV
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Zip | 89106-2962
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Country | US
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Telephone | 725-326-0520
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Fax |
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Authorized Official
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Title or Position | PCA
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Name | PARIS MICHELLE PERKINS
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Credential |
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Telephone | 725-326-0520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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