Basic Information
| Provider Information | |||||||||
| NPI: | 1326415258 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | 702 CAREGIVERS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2780 S JONES BLVD | ||||||||
| Address2: | UNIT 105B | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891465628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023331488 | ||||||||
| FaxNumber: | 7029339547 | ||||||||
| Practice Location | |||||||||
| Address1: | 2780 S JONES BLVD | ||||||||
| Address2: | UNIT 105B | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891465628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023331488 | ||||||||
| FaxNumber: | 7029339547 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2015 | ||||||||
| LastUpdateDate: | 08/26/2015 | ||||||||
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| AuthorizedOfficialLastName: | KOPALYAN | ||||||||
| AuthorizedOfficialFirstName: | NERSES | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7023331488 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PH.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 385H00000X | 7583PCS-0 | NV | Y | Respite Care Facility | Respite Care |
No ID Information.