Basic Information
| Provider Information | |||||||||
| NPI: | 1710058573 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ABSOLUTE HOME CARE INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | ABSOLUTE HOME CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2860 E FLAMINGO RD SUITE K | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023185005 | ||||||||
| FaxNumber: | 7023185006 | ||||||||
| Practice Location | |||||||||
| Address1: | 2860 E FLAMINGO RD STE K | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891215270 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023185005 | ||||||||
| FaxNumber: | 7023185006 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2006 | ||||||||
| LastUpdateDate: | 07/25/2017 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | JIMENEZ | ||||||||
| AuthorizedOfficialFirstName: | EDGAR | ||||||||
| AuthorizedOfficialMiddleName: | VALENTIN | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7023185005 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 302F00000X | N | Managed Care Organizations | Exclusive Provider Organization | 253Z00000X | 20031450181 | NV | Y | Agencies | In Home Supportive Care |
ID Information
| ID | Type | State | Issuer | Description | 1710058573 | 05 | NV | MEDICAID | 100500935 | 05 | NV | MEDICAID |