Healthcare Provider Details

I. General information

NPI: 1457983983
Provider Name (Legal Business Name): SRS HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2020
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2779 W HORIZON RIDGE PKWY STE 130
HENDERSON NV
89052-4186
US

IV. Provider business mailing address

2779 W HORIZON RIDGE PKWY STE 130
HENDERSON NV
89052-4186
US

V. Phone/Fax

Practice location:
  • Phone: 702-589-4975
  • Fax:
Mailing address:
  • Phone: 702-589-4975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code163WR0400X
TaxonomyRehabilitation Registered Nurse
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: STEPHANIE WHALEN
Title or Position: CONTROLLER
Credential:
Phone: 702-990-2290