=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255880118
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A&T CAREGIVERS CONCIERGE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2016
-----------------------------------------------------
Last Update Date | 10/03/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9030 W SAHARA AVE # 183
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89117-5744
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-664-2149
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9030 W SAHARA AVE # 183
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89117-5744
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER
-----------------------------------------------------
Name | PAT ANDERSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 773-259-3979
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | NV20161516202
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------