Healthcare Provider Details

I. General information

NPI: 1285434142
Provider Name (Legal Business Name): CMS HOME HEALTH AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2025
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2559 KILMARON CIR
HENDERSON NV
89014-2214
US

IV. Provider business mailing address

2559 KILMARON CIR
HENDERSON NV
89014-2214
US

V. Phone/Fax

Practice location:
  • Phone: 312-890-5851
  • Fax:
Mailing address:
  • Phone: 312-890-5851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: CHLOE WILSON
Title or Position: ADMINISTRATOR
Credential: RRT
Phone: 312-890-5851