NPIMap

Organization Active NPI

Prestige Care of Nevada LLC

  • Home Health Agency
  • Las Vegas, NV
National Provider Identifier
1710742010
Registry record updated Feb 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
PRESTIGE CARE OF NEVADA LLC
Practice address
1771 E Flamingo Rd Ste 122B
Las Vegas, NV 89119-0839
Phone
(702) 215-9208
NPI assigned
Feb 15, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2024

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

Authorized official

Name
Allen Patcholo Melo Mendoza, REGISTERED NURSE
Title
Administrator
Phone
(702) 217-2676

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

1771 E Flamingo Rd Ste 122B
Las Vegas, NV 89119-0839

Mailing address

1771 E Flamingo Rd Ste 122B
Las Vegas, NV 89119-0839
Phone (702) 215-9208

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240503002481 NV Part A Provider - Home Health Agency 8628418845 Practice locations: Las Vegas, NV

Home health agency certification: CCN 297358

Legal name
PRESTIGE CARE OF NEVADA LLC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Oct 10, 2024
Last certification
Oct 4, 2024
Organization structure
LLCProprietary
Incorporated
Apr 4, 2022 in NV
Enrollment address
1771 E Flamingo Rd
Ste 122B
Las Vegas, NV 89119-0839
HHA Branch

Care Compare: Home health agency

Medicare Care Compare
Listed as
Prestige Care of Nevada LLCCCN 297358
Ownership
-
Certified
Oct 10, 2024
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Locations

1771 E Flamingo Rd
Ste 122B
Las Vegas, NV 89119
Phone (702) 215-9208

Ownership & related parties

All disclosed owners & managing parties 6

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Rizel Abigail Mendoza Individual 5% Or Greater Direct Ownership Interest Apr 4, 2022 16.66%
Joey Albert Mendoza Individual 5% Or Greater Direct Ownership Interest Apr 4, 2022 16.66%
Rolito Visda Individual 5% Or Greater Direct Ownership Interest Apr 4, 2022 16.7%
Francis Laurence Mendoza Individual 5% Or Greater Direct Ownership Interest Apr 4, 2022 16.66%
Allen Patcholo M. Mendoza Individual 5% Or Greater Direct Ownership Interest Apr 4, 2022 16.66%
Operational/Managerial Control Apr 4, 2022 100%
Niel Darrell Mendoza Individual 5% Or Greater Direct Ownership Interest Apr 4, 2022 16.66%

Practitioners & affiliated clinicians

Affiliated clinicians 7

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1707955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707955200000",
    "number": "1710742010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1771 E FLAMINGO RD STE 122B",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891190839",
            "telephone_number": "702-215-9208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1771 E FLAMINGO RD STE 122B",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891190839",
            "telephone_number": "702-215-9208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESTIGE CARE OF NEVADA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-15",
        "last_updated": "2024-02-15",
        "certification_date": "2024-02-15",
        "status": "A",
        "authorized_official_last_name": "MENDOZA",
        "authorized_official_first_name": "ALLEN PATCHOLO",
        "authorized_official_middle_name": "MELO",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "702-217-2676",
        "authorized_official_credential": "REGISTERED NURSE"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.