=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740524545
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEVADA CARENET INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2012
-----------------------------------------------------
Last Update Date | 08/20/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2560 E. SUNSET ROAD SUITE 106
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-202-0552
-----------------------------------------------------
Fax | 702-912-1819
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P O BOX 777122
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89077
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-202-0552
-----------------------------------------------------
Fax | 702-912-1819
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | OGBOUMA OKE ULOFOSHIO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 907-529-1572
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------