MEDICARE: FAMILY PERSONAL 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	251E00000X	Home Health Agency	8062PCS3	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1801247952	OTHER	NV	NPPES
2	1861806408	OTHER	NV	NPPES

General Provider Information

NPI Number	:	1205381522
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY PERSONAL CARE, LLC

Provider Business Mailing Address
First Line	:	4550 W OAKEY BLVD STE 108A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1506
Country	:	US
Telephone Number	:	702-906-1999
Fax Number	:

Provider Business Practice Location Address
First Line	:	4550 W OAKEY BLVD STE 108A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1506
Country	:	US
Telephone Number	:	702-906-1999
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	JUAN A AVILA
Credential	:
Telephone Number	:	702-906-1999

Provider Enumeration Date	:	08/16/2016
Last Update Date	:	08/16/2016

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1801247952 — FAMILY PERSONAL CARE, LLC
Practice Location Address:

4550 W OAKEY BLVD STE 108A
LAS VEGAS, NV
89102-1506

Practice Phone: 702-906-1999
Practice Fax:

Directions to “FAMILY PERSONAL CARE, LLC ” Practice Location

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