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General NPI Number Information
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NPI Number | 1649086372
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Entity Type | Organization
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Legal Business Name | AGAVE SPECIALTY CARE, LLC
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Dates
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Enumeration Date | 12/07/2024
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Last Update Date | 04/03/2025
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Provider Practice Location Address
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Address Line | 3335 RAWHIDE ST
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City | LAS VEGAS
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State | NV
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Zip | 89120-1933
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Country | US
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Telephone | 725-204-9005
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Fax | 702-268-8925
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Provider Business Mailing Address
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Address Line | 2714 DUCK POND CT
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City | HENDERSON
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State | NV
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Zip | 89074-1915
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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
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Name | HOMER SIMS
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Credential |
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Telephone | 702-350-6300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 311500000X
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Taxonomy Name | Alzheimer Center (Dementia Center)
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License Number |
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License Number State |
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