Provider Demographics
NPI:1306242359
Name:ELDERCARE SERVICES LV LLC
Entity type:Organization
Organization Name:ELDERCARE SERVICES LV LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MAISIE MARIEL
Authorized Official - Middle Name:QUINTOS
Authorized Official - Last Name:PASTRANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-480-9006
Mailing Address - Street 1:4324 THUNDER TWICE ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-6071
Mailing Address - Country:US
Mailing Address - Phone:702-396-1030
Mailing Address - Fax:702-395-5377
Practice Address - Street 1:4324 THUNDER TWICE ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-6071
Practice Address - Country:US
Practice Address - Phone:702-396-1030
Practice Address - Fax:702-395-5377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-18
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization