MEDICARE: CREEKSIDE HOME HEALTH CARE

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	297070	NV

General Provider Information

NPI Number	:	1356303713
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CREEKSIDE HOME HEALTH CARE

Provider Business Mailing Address
First Line	:	3675 PECOS MCLEOD
Second Line	:	SUITE #500
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-3815
Country	:	US
Telephone Number	:	702-696-9229
Fax Number	:	702-696-1003

Provider Business Practice Location Address
First Line	:	3675 PECOS MCLEOD
Second Line	:	SUITE #500
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-3815
Country	:	US
Telephone Number	:	702-696-9229
Fax Number	:	702-696-1003

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. JONATHAN R MONKS
Credential	:
Telephone Number	:	702-696-9229

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	04/04/2008

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Directions to “CREEKSIDE HOME HEALTH CARE ” Practice Location

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