MEDICARE: ABSOLUTE HOME CARE INC.

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	302F00000X	Exclusive Provider Organization
2	253Z00000X	In Home Supportive Care Agency	20031450181	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710058573
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABSOLUTE HOME CARE INC.

Provider Business Mailing Address
First Line	:	2860 E FLAMINGO RD SUITE K
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121
Country	:	US
Telephone Number	:	702-318-5005
Fax Number	:	702-318-5006

Provider Business Practice Location Address
First Line	:	2860 E FLAMINGO RD STE K
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5270
Country	:	US
Telephone Number	:	702-318-5005
Fax Number	:	702-318-5006

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. EDGAR VALENTIN JIMENEZ
Credential	:
Telephone Number	:	702-318-5005

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	07/25/2017

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