1114685781 NPI number — TIARA MCCLAIN

Table of content: DR. KNIKKI CHILDS PENDLETON PHARMD (NPI 1912205907)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114685781 NPI number — TIARA MCCLAIN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCLAIN
Provider First Name:
TIARA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114685781
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8670 W CHEYENNE, SUITE 135
Provider Second Line Business Mailing Address:
A HELPING HAND IN HOME HEALTH CARE
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89129
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-822-2600
Provider Business Mailing Address Fax Number:
702-822-1910

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8670 W CHEYENNE, SUITE 135
Provider Second Line Business Practice Location Address:
A HELPING HAND IN HOME HEALTH CARE
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-822-2600
Provider Business Practice Location Address Fax Number:
702-822-1910
Provider Enumeration Date:
12/01/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 374U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3747P1801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)