MEDICARE: PLATINUM CARE NEVADA 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	253Z00000X	In Home Supportive Care Agency
2	253Z00000X	In Home Supportive Care Agency	7476PCS-8	NV

General Provider Information

NPI Number	:	1881032464
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLATINUM CARE NEVADA INC

Provider Business Mailing Address
First Line	:	2540 S MARYLAND PKWY STE 115
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-1627
Country	:	US
Telephone Number	:	702-702-4765
Fax Number	:	702-442-8797

Provider Business Practice Location Address
First Line	:	1555 E FLAMINGO RD STE 117
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5259
Country	:	US
Telephone Number	:	702-476-5597
Fax Number	:	702-442-8797

Authorized Official
Title or Position	:	DIRECTOR
Name	:	LEIZEL JACOBSEN
Credential	:	PCA
Telephone Number	:	702-476-5597

Provider Enumeration Date	:	06/05/2013
Last Update Date	:	02/01/2021

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