MEDICARE: LAS VEGAS HEALTH CARE,LLC LIMITED LIABILITY COMPANY

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		NV

General Provider Information

NPI Number	:	1326559345
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAS VEGAS HEALTH CARE,LLC LIMITED LIABILITY COMPANY

Provider Business Mailing Address
First Line	:	6290 S RAINBOW BLVD STE 9
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-3246
Country	:	US
Telephone Number	:	702-410-8018
Fax Number	:	702-410-8018

Provider Business Practice Location Address
First Line	:	6290 S RAINBOW BLVD STE 9
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-3246
Country	:	US
Telephone Number	:	702-410-8018
Fax Number	:	702-410-8018

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	SHARIFA G WAHAB
Credential	:	ADMINISTRATOR
Telephone Number	:	702-234-9088

Provider Enumeration Date	:	10/17/2017
Last Update Date	:	12/12/2017

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