Provider Demographics
NPI:1730921115
Name:VEGAS LIGHT CARE PCA LLC
Entity type:Organization
Organization Name:VEGAS LIGHT CARE PCA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:KARIM
Authorized Official - Middle Name:
Authorized Official - Last Name:NASSAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-831-7921
Mailing Address - Street 1:9363 VITAL CREST ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-7619
Mailing Address - Country:US
Mailing Address - Phone:702-300-8862
Mailing Address - Fax:
Practice Address - Street 1:9363 VITAL CREST ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-7619
Practice Address - Country:US
Practice Address - Phone:702-300-8862
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care