MEDICARE: SILVER STATE PERSONAL CARE SERVICES 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	:	1609638774
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SILVER STATE PERSONAL CARE SERVICES LLC

Provider Business Mailing Address
First Line	:	1064 E SAHARA AVE STE D
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-3220
Country	:	US
Telephone Number	:	702-806-1456
Fax Number	:

Provider Business Practice Location Address
First Line	:	3765 E SUNSET RD STE B9
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-6208
Country	:	US
Telephone Number	:	866-586-8722
Fax Number	:	866-745-2561

Authorized Official
Title or Position	:	CEO
Name	:	BARON LEARY MENDIOLA
Credential	:
Telephone Number	:	702-806-1456

Provider Enumeration Date	:	01/24/2024
Last Update Date	:	03/18/2025

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