Basic Information
| Provider Information | |||||||||
| NPI: | 1598135543 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NEVADA PCA, LLC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NEVADA PCA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 332 S DECATUR BLVD | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891072804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026655654 | ||||||||
| FaxNumber: | 7026655838 | ||||||||
| Practice Location | |||||||||
| Address1: | 332 S DECATUR BLVD | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891072804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026655654 | ||||||||
| FaxNumber: | 7026655838 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2015 | ||||||||
| LastUpdateDate: | 02/20/2019 | ||||||||
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| AuthorizedOfficialLastName: | JIMENEZ | ||||||||
| AuthorizedOfficialFirstName: | EDGAR | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7022736658 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 253Z00000X | NV | Y | Agencies | In Home Supportive Care |
No ID Information.