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General NPI Number Information
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NPI Number | 1215631650
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Entity Type | Organization
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Legal Business Name | HOME BY JACKIE
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Dates
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Enumeration Date | 03/29/2023
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Last Update Date | 03/29/2023
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Provider Practice Location Address
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Address Line | 4483 W RENO AVE
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City | LAS VEGAS
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State | NV
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Zip | 89118-1527
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Country | US
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Telephone | 702-912-7888
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Fax |
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Provider Business Mailing Address
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Address Line | 4483 W RENO AVE
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City | LAS VEGAS
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State | NV
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Zip | 89118-1527
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Country | US
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Telephone | 702-912-7888
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Fax |
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | VANESSA WYNII OW
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Credential |
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Telephone | 702-769-5152
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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