Healthcare Provider Details

I. General information

NPI: 1295248573
Provider Name (Legal Business Name): NELLIS HOME HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 E TWAIN AVE # 103
LAS VEGAS NV
89169-4928
US

IV. Provider business mailing address

455 E TWAIN AVE # 103
LAS VEGAS NV
89169-4928
US

V. Phone/Fax

Practice location:
  • Phone: 702-401-1121
  • Fax:
Mailing address:
  • Phone: 702-401-1121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License NumberE03086320168
License Number StateNV

VIII. Authorized Official

Name: MISS ROSEANNE W JONES
Title or Position: OWNER
Credential:
Phone: 702-401-1121