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General NPI Number Information
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NPI Number | 1548591852
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Entity Type | Organization
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Legal Business Name | PRIMECARE HOMEHEALTH AGENCY,LLC
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Dates
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Enumeration Date | 01/26/2010
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Last Update Date | 01/26/2010
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Provider Practice Location Address
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Address Line | 3160 W SAHARA AVE SUITE A25
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City | LAS VEGAS
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State | NV
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Zip | 89102-6003
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Country | US
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Telephone | 702-457-9000
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Fax | 702-457-9005
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Provider Business Mailing Address
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Address Line | 3160 W SAHARA AVE SUITE A25
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City | LAS VEGAS
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State | NV
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Zip | 89102-6003
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Country | US
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Telephone | 702-457-9000
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Fax | 702-457-9005
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MRS. LOLITA E CHING
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Credential | RN
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Telephone | 702-286-1381
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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 | H14-00271-E-147574
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License Number State | NV
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