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NPI Code Detail

MEDICARE: ELSUBE LLC

MEDICARE: ELSUBE LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251E00000XHome Health Agency

General Provider Information

NPI Number : 1053748301
Entity Type Code : Organization
Provider Name (Legal Business Name) : ELSUBE LLC
Provider Business Mailing Address
First Line : 417 FOXVALE AVE
Second Line :
City : N LAS VEGAS
State : NV
Zip : 89032-6150
Country : US
Telephone Number : 702-643-1552
Fax Number :
Provider Business Practice Location Address
First Line : 417 FOXVALE AVE
Second Line :
City : N LAS VEGAS
State : NV
Zip : 89032-6150
Country : US
Telephone Number : 702-643-1552
Fax Number :
Authorized Official
Title or Position : MANAGING PARTNER
Name : MRS. ELODIA MAYNARD
Credential : CNA
Telephone Number : 702-643-1552
Provider Enumeration Date : 10/02/2013
Last Update Date : 10/02/2013

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Directions to “ELSUBE LLC ” Practice Location

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