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NPI Code Detail

MEDICARE: MAMA HOME CARE, LLC

MEDICARE: MAMA HOME 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
1253Z00000XIn Home Supportive Care Agency

General Provider Information

NPI Number : 1295500114
Entity Type Code : Organization
Provider Name (Legal Business Name) : MAMA HOME CARE, LLC
Provider Business Mailing Address
First Line : 1401 ARVILLE ST STE G
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-0537
Country : US
Telephone Number : 702-738-0515
Fax Number : 702-527-7698
Provider Business Practice Location Address
First Line : 1401 ARVILLE ST STE G
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-0537
Country : US
Telephone Number : 702-738-0515
Fax Number : 702-527-7698
Authorized Official
Title or Position : ADMINISTRATOR
Name : ALEXIS DAVID KIM
Credential :
Telephone Number : 702-738-0515
Provider Enumeration Date : 11/21/2023
Last Update Date : 09/29/2024

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Directions to “MAMA HOME CARE, LLC ” Practice Location

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