MEDICARE: CONNOLLY ENTERPRISES 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
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1073025060
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONNOLLY ENTERPRISES LLC

Provider Business Mailing Address
First Line	:	2378 VALISSA ST
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89044-0535
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8870 S MARYLAND PKWY STE 125
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-4010
Country	:	US
Telephone Number	:	702-426-5165
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MICHAEL CONNOLLY
Credential	:
Telephone Number	:	702-426-5165

Provider Enumeration Date	:	10/30/2017
Last Update Date	:	03/27/2021

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