Healthcare Provider Details

I. General information

NPI: 1205727294
Provider Name (Legal Business Name): OBA 2 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2025
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6755 W CHARLESTON BLVD STE B
LAS VEGAS NV
89146-9000
US

IV. Provider business mailing address

6755 W CHARLESTON BLVD STE B
LAS VEGAS NV
89146-9000
US

V. Phone/Fax

Practice location:
  • Phone: 775-471-7723
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MIRO OBA
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 775-471-7723