MEDICARE: NORTH LAS VEGAS PERSONAL 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
1	251E00000X	Home Health Agency
2	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1821630401
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH LAS VEGAS PERSONAL CARE, LLC

Provider Business Mailing Address
First Line	:	3050 W CHEYENNE AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-6025
Country	:	US
Telephone Number	:	702-444-7624
Fax Number	:

Provider Business Practice Location Address
First Line	:	3050 W CHEYENNE AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-6025
Country	:	US
Telephone Number	:	702-444-7624
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	SAI MACKIE
Credential	:
Telephone Number	:	702-444-7624

Provider Enumeration Date	:	10/15/2019
Last Update Date	:	10/15/2019

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