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General NPI Number Information
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NPI Number | 1306242359
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Entity Type | Organization
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Legal Business Name | ELDERCARE SERVICES LV LLC
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Dates
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Enumeration Date | 11/18/2014
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Last Update Date | 11/18/2014
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Provider Practice Location Address
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Address Line | 4324 THUNDER TWICE ST
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City | LAS VEGAS
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State | NV
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Zip | 89129-6071
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Country | US
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Telephone | 702-396-1030
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Fax | 702-395-5377
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Provider Business Mailing Address
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Address Line | 4324 THUNDER TWICE ST
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City | LAS VEGAS
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State | NV
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Zip | 89129-6071
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Country | US
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Telephone | 702-396-1030
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Fax | 702-395-5377
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MISS MAISIE MARIEL QUINTOS PASTRANO
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Credential |
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Telephone | 702-480-9006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State |
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