Healthcare Provider Details

I. General information

NPI: 1841577921
Provider Name (Legal Business Name): ISU INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2011
Last Update Date: 11/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1745 N. NELLIS BLVD STE A
LAS VEGAS NV
89115-3673
US

IV. Provider business mailing address

1745 N. NELLIS BLVD STE A
LAS VEGAS NV
89115-3673
US

V. Phone/Fax

Practice location:
  • Phone: 702-459-7500
  • Fax: 702-459-1176
Mailing address:
  • Phone: 702-459-7500
  • Fax: 702-459-1176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number6374PCS-0
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number6033HHA-O
License Number StateNV

VIII. Authorized Official

Name: DR. CHUKA E HUMPHREYS
Title or Position: PRESIDENT
Credential: PHD
Phone: 702-459-7500