MEDICARE: PERSONAL CARE NEVADA 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1043939861
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERSONAL CARE NEVADA LLC

Provider Business Mailing Address
First Line	:	6245 HARRISON DR STE 6
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-4035
Country	:	US
Telephone Number	:	725-300-0104
Fax Number	:	725-300-0446

Provider Business Practice Location Address
First Line	:	6245 HARRISON DR STE 6
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-4035
Country	:	US
Telephone Number	:	725-300-0104
Fax Number	:	725-300-0446

Authorized Official
Title or Position	:	OWNER
Name	:	JESSICA DAVIS
Credential	:
Telephone Number	:	725-300-0104

Provider Enumeration Date	:	08/24/2022
Last Update Date	:	08/24/2022

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