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General NPI Number Information
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NPI Number | 1710233317
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Entity Type | Organization
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Legal Business Name | FONG HOME HEALTH CARE
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Dates
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Enumeration Date | 08/01/2012
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Last Update Date | 08/01/2012
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Provider Practice Location Address
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Address Line | 50 N. HONOLULU STREET SUITE 130
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City | LAS VEGAS
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State | NV
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Zip | 89110
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Country | US
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Telephone | 702-463-2760
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Fax | 702-463-2760
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Provider Business Mailing Address
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Address Line | 50 N. HONOLULU STREET SUITE 130
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City | LAS VEGAS
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State | NV
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Zip | 89110
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Country | US
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Telephone | 702-463-2760
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Fax | 702-463-2760
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Authorized Official
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Title or Position | OWNER
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Name | ALTAGRACIA FONG
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Credential | P.C.A
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Telephone | 702-463-2760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 6267PCS-0
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License Number State | NV
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