MEDICARE: ALISSAS PERSONAL CARE SERVICESLLC

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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1164936605
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALISSAS PERSONAL CARE SERVICESLLC

Provider Business Mailing Address
First Line	:	1650 E SAHARA AVE STE 1
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-3495
Country	:	US
Telephone Number	:	702-265-8130
Fax Number	:

Provider Business Practice Location Address
First Line	:	1650 E SAHARA AVE STE 1
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-3495
Country	:	US
Telephone Number	:	702-265-8130
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SONIA LOPEZ
Credential	:
Telephone Number	:	702-265-8130

Provider Enumeration Date	:	11/20/2017
Last Update Date	:	11/20/2017

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