MEDICARE: GROOVER CARE 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	NV20121250799	NV
2	253Z00000X	In Home Supportive Care Agency	NV20121087492	NV

General Provider Information

NPI Number	:	1114291986
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GROOVER CARE LLC

Provider Business Mailing Address
First Line	:	1951 STELLA LAKE ST STE 17
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-2143
Country	:	US
Telephone Number	:	702-885-9595
Fax Number	:

Provider Business Practice Location Address
First Line	:	1951 STELLA LAKE ST STE 17
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-2143
Country	:	US
Telephone Number	:	702-885-9595
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DANETTE GROOVER
Credential	:
Telephone Number	:	702-885-9595

Provider Enumeration Date	:	02/27/2012
Last Update Date	:	12/06/2013

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