MEDICARE: JCR 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	311ZA0620X	Adult Care Home Facility	4093AGZ-12	NV

General Provider Information

NPI Number	:	1750832549
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JCR HOME CARE, INC.

Provider Business Mailing Address
First Line	:	7160 DARBY AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-3122
Country	:	US
Telephone Number	:	702-203-3450
Fax Number	:	702-252-5092

Provider Business Practice Location Address
First Line	:	7160 DARBY AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-3122
Country	:	US
Telephone Number	:	702-203-3450
Fax Number	:	702-252-5092

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JASMINE CASTILLO
Credential	:
Telephone Number	:	702-203-3450

Provider Enumeration Date	:	10/17/2016
Last Update Date	:	10/17/2016

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