MEDICARE: WE CARE RESIDENTIAL HOME, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	9026-AGC-0	NV

General Provider Information

NPI Number	:	1013403138
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WE CARE RESIDENTIAL HOME, LLC

Provider Business Mailing Address
First Line	:	3858 MOONGATE CIR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-0134
Country	:	US
Telephone Number	:	702-945-6682
Fax Number	:	702-251-0335

Provider Business Practice Location Address
First Line	:	3858 MOONGATE CIR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-0134
Country	:	US
Telephone Number	:	702-945-6682
Fax Number	:	702-251-0335

Authorized Official
Title or Position	:	FACILITY MANAGER/OWNER
Name	:	JUDITH LANGEN
Credential	:
Telephone Number	:	702-945-6682

Provider Enumeration Date	:	07/02/2018
Last Update Date	:	07/02/2018

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