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General NPI Number Information
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NPI Number | 1093399230
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Entity Type | Organization
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Legal Business Name | THE WOOD AGENCY HOME & LIFE
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Dates
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Enumeration Date | 05/12/2021
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Last Update Date | 11/29/2021
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Provider Practice Location Address
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Address Line | 2350 S JONES BLVD STE 219
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City | LAS VEGAS
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State | NV
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Zip | 89146-3103
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Country | US
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Telephone | 702-530-8298
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Fax |
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Provider Business Mailing Address
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Address Line | 3157 N RAINBOW BLVD # 192
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City | LAS VEGAS
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State | NV
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Zip | 89108-4578
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Country | US
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Telephone | 702-530-8298
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | TIFFANIE WOOD
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Credential |
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Telephone | 702-530-8298
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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