MEDICARE: DOVE 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1285347328
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOVE PERSONAL CARE LLC

Provider Business Mailing Address
First Line	:	4820 EL ESCORIAL DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-6805
Country	:	US
Telephone Number	:	702-510-9229
Fax Number	:

Provider Business Practice Location Address
First Line	:	4820 EL ESCORIAL DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-6805
Country	:	US
Telephone Number	:	702-510-9229
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	REINIER GANDOL MOLA
Credential	:
Telephone Number	:	702-510-9229

Provider Enumeration Date	:	01/04/2023
Last Update Date	:	01/04/2023

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Directions to “DOVE PERSONAL CARE LLC ” Practice Location

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