MEDICARE: MOUNTAIN CREST 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		NV

General Provider Information

NPI Number	:	1902132954
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAIN CREST HOME HEALTH, LLC

Provider Business Mailing Address
First Line	:	10501 W GOWAN RD STE 170
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-6603
Country	:	US
Telephone Number	:	702-785-0128
Fax Number	:	702-785-0127

Provider Business Practice Location Address
First Line	:	10501 W GOWAN RD STE 170
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-6603
Country	:	US
Telephone Number	:	702-785-0128
Fax Number	:	702-785-0127

Authorized Official
Title or Position	:	CEO
Name	:	NONA BAUTISTA
Credential	:
Telephone Number	:	702-785-0128

Provider Enumeration Date	:	10/27/2009
Last Update Date	:	06/25/2019

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