Healthcare Provider Details

I. General information

NPI: 1518558113
Provider Name (Legal Business Name): CREST POINT HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2021
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 S EASTERN AVE
LAS VEGAS NV
89104-3943
US

IV. Provider business mailing address

1717 S EASTERN AVE
LAS VEGAS NV
89104-3943
US

V. Phone/Fax

Practice location:
  • Phone: 702-330-0232
  • Fax: 702-333-0545
Mailing address:
  • Phone: 702-330-0232
  • Fax: 702-333-0545

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: OKECHUKWU PRINCE ETONIRU
Title or Position: ADMINISTRATOR, RN
Credential:
Phone: 702-984-8377