Healthcare Provider Details

I. General information

NPI: 1235625799
Provider Name (Legal Business Name): FELICITY HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2018
Last Update Date: 07/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7495 W AZURE DR STE 109
LAS VEGAS NV
89130-4416
US

IV. Provider business mailing address

7495 W AZURE DR STE 109
LAS VEGAS NV
89130-4416
US

V. Phone/Fax

Practice location:
  • Phone: 702-582-5950
  • Fax:
Mailing address:
  • Phone: 702-582-5950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License Number
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207VH0002X
TaxonomyHospice and Palliative Medicine (Obstetrics & Gynecology) Physician
License Number
License Number State

VIII. Authorized Official

Name: AYREO MARIE GRAY
Title or Position: PRESIDENT/CEO
Credential:
Phone: 702-582-5950