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Organization
PROVIDENCE HEALTHCARE OF NEVADA LLC
Active
Organization
PROVIDENCE HEALTHCARE OF NEVADA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GERARD M TABORA (ADMINISTRATOR)
(702) 680-0235
Entity
Organization
Contact information
Practice address
5510 S FORT APACHE RD, STE 18, LAS VEGAS, NV 89148-7700
(702) 680-0235
(702) 680-0236
Mailing address
5510 S FORT APACHE RD, STE 18, LAS VEGAS, NV 89148-7700
(702) 680-0235
(702) 680-0236
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NV20171115640
NEVADA SECRETARY OF STATE
NV
Enumeration date
05/02/2017
Last updated
05/02/2017
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