Basic Information
| Provider Information | |||||||||
| NPI: | 1194297234 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HIGH CLASS PERSONAL CARE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5000 W OAKEY BLVD STE E1 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891463398 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027332890 | ||||||||
| FaxNumber: | 7027334951 | ||||||||
| Practice Location | |||||||||
| Address1: | 5000 W OAKEY BLVD STE E1 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891463398 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027332890 | ||||||||
| FaxNumber: | 7027334951 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/31/2018 | ||||||||
| LastUpdateDate: | 12/31/2018 | ||||||||
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| AuthorizedOfficialLastName: | JIMENEZ | ||||||||
| AuthorizedOfficialFirstName: | EDGAR | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7022736658 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 253Z00000X | Y | Agencies | In Home Supportive Care |
ID Information
| ID | Type | State | Issuer | Description | 9005056385 | 01 | NV | API | OTHER |