Provider Demographics
NPI:1871077263
Name:PARTNERS IN CARE NEVADA
Entity type:Organization
Organization Name:PARTNERS IN CARE NEVADA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER/ OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BEHAYILU
Authorized Official - Middle Name:MERID
Authorized Official - Last Name:DUBALE
Authorized Official - Suffix:
Authorized Official - Credentials:PROGRAM DIRECTOR
Authorized Official - Phone:602-814-1612
Mailing Address - Street 1:10053 SAN GERVASIO AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-7202
Mailing Address - Country:US
Mailing Address - Phone:702-818-0289
Mailing Address - Fax:
Practice Address - Street 1:10053 SAN GERVASIO AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-7202
Practice Address - Country:US
Practice Address - Phone:702-818-0289
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARTNERS IN CARE NEVADA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility