San Vicente Home Care, LLC

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

358-AGC-25 Issued in NV

Legal business name

SAN VICENTE HOME CARE, LLC

Practice address

8460 Rancho Destino Rd
Las Vegas, NV 89123-1633

Phone

(702) 324-4442

Fax

(702) 263-7065

NPI assigned

Sep 11, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Visitacion T Dela Pena, RN

Title

Administrator

Phone

(702) 324-4442

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1505088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1073032090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8460 RANCHO DESTINO RD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891231633",
            "telephone_number": "702-324-4442",
            "fax_number": "702-263-7065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8460 RANCHO DESTINO RD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891231633",
            "telephone_number": "702-324-4442",
            "fax_number": "702-263-7065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN VICENTE HOME CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-11",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "DELA PENA",
        "authorized_official_first_name": "VISITACION",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "702-324-4442",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NV",
            "license": "358-AGC-25",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005702025",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Adult Care Home Facility in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Adult Care Home Facility in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.