MEDICARE: OATH HEALTHCARE 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	253Z00000X	In Home Supportive Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1405303547	OTHER	NV	ID

General Provider Information

NPI Number	:	1376157495
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OATH HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	4547 DOVER STRAIGHT ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89115-2109
Country	:	US
Telephone Number	:	702-831-2223
Fax Number	:

Provider Business Practice Location Address
First Line	:	4547 DOVER STRAIGHT ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89115-2109
Country	:	US
Telephone Number	:	702-831-2223
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DEONNA MCREYNOLDS
Credential	:
Telephone Number	:	702-831-2223

Provider Enumeration Date	:	09/04/2020
Last Update Date	:	09/04/2020

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Directions to “OATH HEALTHCARE LLC ” Practice Location

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