Healthcare Provider Details

I. General information

NPI: 1679743066
Provider Name (Legal Business Name): LAS VEGAS HOME HEALTH AGNECY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2008
Last Update Date: 03/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 S PECOS RD STE 17
LAS VEGAS NV
89121-5027
US

IV. Provider business mailing address

4160 S PECOS RD STE 17
LAS VEGAS NV
89121-5027
US

V. Phone/Fax

Practice location:
  • Phone: 702-433-5368
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberGF-25401000
License Number StateNV

VIII. Authorized Official

Name: MRS. YELENA YEKTA
Title or Position: PRESIDENT
Credential:
Phone: 702-433-5368