Basic Information
| Provider Information | |||||||||
| NPI: | 1518422583 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOMEBASE HEALTHCARE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3312 W CHARLESTON BLVD | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891021829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024107825 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3312 W CHARLESTON BLVD | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891021829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024107825 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2019 | ||||||||
| LastUpdateDate: | 02/05/2019 | ||||||||
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| AuthorizedOfficialLastName: | MALINIS | ||||||||
| AuthorizedOfficialFirstName: | FRANCES | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 7024107825 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QG0300X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.