- Enrollment id
- O20200825002413
- Enrollment state
- NV
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1447802574
- Multiple npi flag
- N
- Ccn
- 297307
- Associate id
- 6002233822
- Organization name
- IDEAL CARE HEALTH SERVICES LLC
- Incorporation date
- 2018-05-20
- Incorporation state
- NV
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 1641 E FLAMINGO RD
- Address line 2
- STE 13
- City
- LAS VEGAS
- State
- NV
- Zip code
- 891195257