MEDICARE: NATIONAL NUCLEAR ENERGY 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1467120139
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATIONAL NUCLEAR ENERGY HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	2012 SAN JUAN BLVD
Second Line	:
City	:	FARMINGTON
State	:	NM
Zip	:	87401-2220
Country	:	US
Telephone Number	:	505-402-4067
Fax Number	:	505-436-2294

Provider Business Practice Location Address
First Line	:	9480 S EASTERN AVE STE 272
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-8000
Country	:	US
Telephone Number	:	505-402-4067
Fax Number	:	505-436-2294

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. JARED FOUTZ
Credential	:
Telephone Number	:	505-402-4067

Provider Enumeration Date	:	08/30/2021
Last Update Date	:	05/04/2022

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