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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
1376J00000XHomemaker20121700531NV

General Provider Information

NPI Number : 1063889459
Entity Type Code : Organization
Provider Name (Legal Business Name) : ELSUBE LLC
Provider Business Mailing Address
First Line : 417 FOXVALE AVE
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89032-6150
Country : US
Telephone Number : 702-463-0082
Fax Number : 702-463-0104
Provider Business Practice Location Address
First Line : 417 FOXVALE AVE
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89032-6150
Country : US
Telephone Number : 702-463-0082
Fax Number : 702-463-0104
Authorized Official
Title or Position : MANAGER
Name : MRS. ELODIA MAYNARD
Credential :
Telephone Number : 702-463-0082
Provider Enumeration Date : 09/01/2015
Last Update Date : 09/01/2015

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Directions to “ELSUBE LLC ” Practice Location

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