=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285033456
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EM HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2014
-----------------------------------------------------
Last Update Date | 08/14/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3430 E FLAMINGO RD SUITE 240
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89121-5003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-522-0927
-----------------------------------------------------
Fax | 702-425-9825
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3430 E FLAMINGO RD SUITE 240
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89121-5003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-522-0927
-----------------------------------------------------
Fax | 702-425-9825
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MR. GUALBERTO RAQUID MORCO V
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 702-577-8393
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number | 8036PCS-0
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------