MEDICARE: ALTA CARE HOMEHEALTH, INC,

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	NV20141141146681	NV

General Provider Information

NPI Number	:	1659781607
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALTA CARE HOMEHEALTH, INC,

Provider Business Mailing Address
First Line	:	6280 S VALLEY VIEW BLVD STE 120
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-3814
Country	:	US
Telephone Number	:	702-478-9934
Fax Number	:	702-478-9461

Provider Business Practice Location Address
First Line	:	6280 S VALLEY VIEW BLVD STE 120
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-3814
Country	:	US
Telephone Number	:	702-478-9934
Fax Number	:	702-478-9461

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. WILMER AQUINO COMAHIG
Credential	:	RN
Telephone Number	:	702-478-9934

Provider Enumeration Date	:	04/30/2014
Last Update Date	:	04/08/2020

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