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SAN VICENTE HOME CARE LLC NPI 1073032090


NPI Information

NPI: 1073032090
Provider Name: SAN VICENTE HOME CARE, LLC
Classification: Custodial Care Facility - 311ZA0620X
Entity Type: Organization

Specialization: Adult Care Home

Address:
8460 RANCHO DESTINO RD
LAS VEGAS, NV
ZIP 89123
Phone: (702) 324-4442
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SAN VICENTE HOME CARE, LLC is an adult care home custodial care facility in Las Vegas, NV. The provider is a custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment. SAN VICENTE HOME CARE, LLC NPI is 1073032090. The provider is registered as an organization entity type.

The provider's business location address is:

8460 RANCHO DESTINO RD
LAS VEGAS, NV
ZIP 89123-633
Phone: (702) 324-4442
Fax: (702) 263-7065

The provider's authorized official is Visitacion T Dela Pena .
The authorized official title is Administrator and has the following contact phone number (702) 324-4442.

The enumeration date for this NPI number is 9/11/2017 and was last updated on 9/11/2017.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1311ZA0620XCustodial Care FacilityAdult Care Home358-AGC-25NEVADAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1005702025MEDICAIDNEVADA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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