MEDICARE: NATIVE HOME HEALTH CARE, 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	302R00000X	Health Maintenance Organization	116513	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336108810
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATIVE HOME HEALTH CARE, LLC

Provider Business Mailing Address
First Line	:	2235 E FLAMINGO RD
Second Line	:	SUITE C-7
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5129
Country	:	US
Telephone Number	:	702-862-4177
Fax Number	:	702-862-4185

Provider Business Practice Location Address
First Line	:	2235 E FLAMINGO RD
Second Line	:	SUITE C-7
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5129
Country	:	US
Telephone Number	:	702-862-4177
Fax Number	:	702-862-4185

Authorized Official
Title or Position	:	OWNER
Name	:	ANGEL JACKSON
Credential	:	ADMINISTRATOR
Telephone Number	:	702-862-4177

Provider Enumeration Date	:	03/22/2006
Last Update Date	:	09/29/2008

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