Provider Demographics
NPI:1861996324
Name:PRINCESS PERSONAL CARE , LLC
Entity type:Organization
Organization Name:PRINCESS PERSONAL CARE , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:OYIBO
Authorized Official - Middle Name:
Authorized Official - Last Name:IGBOAMAZU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-327-9012
Mailing Address - Street 1:4640 W CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1503
Mailing Address - Country:US
Mailing Address - Phone:702-822-1400
Mailing Address - Fax:
Practice Address - Street 1:4640 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1503
Practice Address - Country:US
Practice Address - Phone:702-822-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care