MEDICARE: ONE HUNDRED PERCENT WELL 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	:	1891078036
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ONE HUNDRED PERCENT WELL LLC

Provider Business Mailing Address
First Line	:	4559 SPARWOOD DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-8212
Country	:	US
Telephone Number	:	702-275-5190
Fax Number	:	702-275-5190

Provider Business Practice Location Address
First Line	:	4559 SPARWOOD DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-8212
Country	:	US
Telephone Number	:	702-275-5190
Fax Number	:	702-275-5190

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RODERICK ADAMS
Credential	:
Telephone Number	:	702-275-5190

Provider Enumeration Date	:	09/23/2011
Last Update Date	:	09/23/2011

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