=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063391779
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMG HOME HEALTH OF LAS VEGAS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2025
-----------------------------------------------------
Last Update Date | 08/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9510 W SAHARA AVE STE 225
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89117-8812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-843-1353
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9510 W SAHARA AVE STE 225
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89117-8812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-843-1353
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | THOMAS W FENDER III
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 702-237-0216
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------