Organization
SAN VICENTE HOME CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VISITACION T DELA PENA RN (ADMINISTRATOR)
(702) 324-4442
Entity
Organization
Contact information
Practice address
8460 RANCHO DESTINO RD, LAS VEGAS, NV 89123-1633
(702) 324-4442
(702) 263-7065
Mailing address
8460 RANCHO DESTINO RD, LAS VEGAS, NV 89123-1633
(702) 324-4442
(702) 263-7065
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
358-AGC-25
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005702025
—
NV
Enumeration date
09/11/2017
Last updated
07/21/2022
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