NPIMap

Organization Active NPI

Agave Specialty Care, LLC

Doing business as Agave Specialty Care

  • Alzheimer Center (Dementia Center)
  • Las Vegas, NV
National Provider Identifier
1649086372
Registry record updated Apr 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Alzheimer Center (Dementia Center)Taxonomy code 311500000X
Legal business name
AGAVE SPECIALTY CARE, LLC
Doing business as
Agave Specialty Care
Practice address
3335 Rawhide St
Las Vegas, NV 89120-1933
Phone
(725) 204-9005
Fax
(702) 268-8925
NPI assigned
Dec 7, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2025

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

Authorized official

Name
Homer SimsNPI 1194154849
Title
Owner
Phone
(702) 350-6300

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Alzheimer Center (Dementia Center) 311500000X Primary
Adult Care Home Facility 311ZA0620X

Addresses

Primary practice location

3335 Rawhide St
Las Vegas, NV 89120-1933

Mailing address

2714 Duck Pond CT
Henderson, NV 89074-1915

Other names 1

  • Agave Specialty Care Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1733529600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743638400000",
    "number": "1649086372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2714 DUCK POND CT",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890741915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3335 RAWHIDE ST",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891201933",
            "telephone_number": "725-204-9005",
            "fax_number": "702-268-8925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGAVE SPECIALTY CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-07",
        "last_updated": "2025-04-03",
        "certification_date": "2025-04-03",
        "status": "A",
        "authorized_official_last_name": "SIMS",
        "authorized_official_first_name": "HOMER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "702-350-6300"
    },
    "taxonomies": [
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Agave Specialty Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Agave Specialty Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2025; 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.