Healthcare Provider Details

I. General information

NPI: 1336108810
Provider Name (Legal Business Name): NATIVE HOME HEALTH CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 09/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2235 E FLAMINGO RD SUITE C-7
LAS VEGAS NV
89119-5129
US

IV. Provider business mailing address

2235 E FLAMINGO RD SUITE C-7
LAS VEGAS NV
89119-5129
US

V. Phone/Fax

Practice location:
  • Phone: 702-862-4177
  • Fax: 702-862-4185
Mailing address:
  • Phone: 702-862-4177
  • Fax: 702-862-4185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number116513
License Number StateNV

VIII. Authorized Official

Name: ANGEL JACKSON
Title or Position: OWNER
Credential: ADMINISTRATOR
Phone: 702-862-4177