Basic Information
| Provider Information | |||||||||
| NPI: | 1225376759 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | 702 CAREGIVERS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2780 S JONES BLVD 105B | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891465625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023331488 | ||||||||
| FaxNumber: | 7023331490 | ||||||||
| Practice Location | |||||||||
| Address1: | 2780 S JONES BLVD 105B | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891465625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023331488 | ||||||||
| FaxNumber: | 7023331490 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2013 | ||||||||
| LastUpdateDate: | 01/17/2013 | ||||||||
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| AuthorizedOfficialLastName: | KOPALYAN | ||||||||
| AuthorizedOfficialFirstName: | NERSES | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7023331488 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | M.A., (PHD PENDING) | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 253Z00000X | Y | Agencies | In Home Supportive Care |
No ID Information.