=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518412352
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IMMEDIATE PERSONAL CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2016
-----------------------------------------------------
Last Update Date | 08/20/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2820 W CHARLESTON BLVD STE 8
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89102-1929
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-586-7431
-----------------------------------------------------
Fax | 702-586-7260
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2560 E SUNSET RD SUITE 118
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89120-3516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 907-529-1572
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | OGBOUMA OKE ULOFOSHIO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 907-529-1572
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 376J00000X
-----------------------------------------------------
Taxonomy Name | Homemaker
-----------------------------------------------------
License Number | 8227-PCO-0
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------