=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629351440
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY CARE HOME HEALTH & HOSPICE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2011
-----------------------------------------------------
Last Update Date | 01/03/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6960 OBANNON DR STE 130
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89117-2160
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-445-1354
-----------------------------------------------------
Fax | 702-650-9388
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1945 E WARM SPRINGS RD STE 400
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89119-4583
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-650-9366
-----------------------------------------------------
Fax | 702-650-9388
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR/OWNER
-----------------------------------------------------
Name | DR. MOHAMMED AHMED
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 702-445-1354
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------