MEDICARE: MT CARMEL HOME HEALTH 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NV20212274841	OTHER	NV	NEVADA SECRETARY OF STATE

General Provider Information

NPI Number	:	1801548284
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MT CARMEL HOME HEALTH LLC

Provider Business Mailing Address
First Line	:	6268 SPRING MOUNTAIN RD STE 110B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-8874
Country	:	US
Telephone Number	:	702-954-5670
Fax Number	:	702-954-5680

Provider Business Practice Location Address
First Line	:	6268 SPRING MOUNTAIN RD STE 110B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-8874
Country	:	US
Telephone Number	:	702-954-5670
Fax Number	:	702-954-5680

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	PERLA TAGALICUD BAUTISTA
Credential	:
Telephone Number	:	702-954-5670

Provider Enumeration Date	:	01/26/2022
Last Update Date	:	01/26/2022

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