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General NPI Number Information
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NPI Number | 1588020838
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL IN-HOME CARE AGENCY
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Dates
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Enumeration Date | 12/31/2015
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Last Update Date | 12/31/2015
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Provider Practice Location Address
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Address Line | 739 CAMINO DEL RAY
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City | HENDERSON
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State | NV
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Zip | 89012-2610
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Country | US
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Telephone | 702-586-2891
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Fax |
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Provider Business Mailing Address
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Address Line | 739 CAMINO DEL RAY
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City | HENDERSON
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State | NV
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Zip | 89012-2610
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATIONS MANAGER
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Name | MERLA PELAYO
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Credential |
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Telephone | 702-586-2891
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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 | 7922PCS-0
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License Number State | NV
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