MEDICARE: C2C HOME 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1922836600
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	C2C HOME CARE LLC

Provider Business Mailing Address
First Line	:	6308 DUSTY MILE CT
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-1697
Country	:	US
Telephone Number	:	702-355-0044
Fax Number	:

Provider Business Practice Location Address
First Line	:	6308 DUSTY MILE CT
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-1697
Country	:	US
Telephone Number	:	702-355-0044
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ARTIN EISHAKHANIAN
Credential	:
Telephone Number	:	702-355-0044

Provider Enumeration Date	:	07/23/2024
Last Update Date	:	07/23/2024

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