Provider Demographics
NPI:1366182909
Name:BATTLE BORN HOME CARE LLC
Entity type:Organization
Organization Name:BATTLE BORN HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:760-989-2518
Mailing Address - Street 1:9977 DESERT BIGHORN CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89166-5184
Mailing Address - Country:US
Mailing Address - Phone:760-989-2518
Mailing Address - Fax:
Practice Address - Street 1:7469 W LAKE MEAD BLVD STE 140
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-1030
Practice Address - Country:US
Practice Address - Phone:702-919-0231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care