Organization
PLAXIA CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICHOLE CROCK ADMINISTRATOR (OWNER)
(702) 858-4559
Entity
Organization
Contact information
Practice address
5095 N PARK ST, LAS VEGAS, NV 89149-2522
(702) 858-4559
(810) 885-0572
Mailing address
4565 N CHIEFTAIN ST, LAS VEGAS, NV 89129-2608
(702) 858-4559
(810) 885-0572
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10219-AGC-0
HEALTH AND HUMAN SERVICES DIVISION OF PUBIC AND BEHAVIORAL HEALTH
NV
01
—
NV20191673366
SECRETARY OF STATE
NV
Enumeration date
11/13/2020
Last updated
11/13/2020
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