# SAN VICENTE HOME CARE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073032090
- **Authorized official:** VISITACION T DELA PENA RN (ADMINISTRATOR)
- **Authorized official phone:** (702) 324-4442

## Contact information

- **Practice address:** 8460 RANCHO DESTINO RD, LAS VEGAS, NV 89123-1633
- **Practice address phone:** (702) 324-4442
- **Practice address fax:** (702) 263-7065
- **Mailing address:** 8460 RANCHO DESTINO RD, LAS VEGAS, NV 89123-1633
- **Mailing address phone:** (702) 324-4442
- **Mailing address fax:** (702) 263-7065

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | 358-AGC-25 | NV | Yes |

## Other

- **Enumeration date:** 09/11/2017
- **Last updated:** 07/21/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 005702025 | — | NV |