MEDICARE: GREATER VEGAS PERSONAL CARE

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	132986	NV

General Provider Information

NPI Number	:	1881654093
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREATER VEGAS PERSONAL CARE

Provider Business Mailing Address
First Line	:	336 S JONES BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-2623
Country	:	US
Telephone Number	:	702-735-8884
Fax Number	:	702-735-8886

Provider Business Practice Location Address
First Line	:	336 S JONES BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-2623
Country	:	US
Telephone Number	:	702-735-8884
Fax Number	:	702-735-8886

Authorized Official
Title or Position	:	MEMBER
Name	:	MRS. FABIANA ALFARO
Credential	:
Telephone Number	:	702-735-8884

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	08/22/2020

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Directions to “GREATER VEGAS PERSONAL CARE ” Practice Location

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