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General NPI Number Information
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NPI Number | 1699722454
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Entity Type | Organization
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Legal Business Name | MARY HOME HEALTH, INC.
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Dates
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Enumeration Date | 05/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2770 S MARYLAND PKWY
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City | LAS VEGAS
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State | NV
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Zip | 89109-1554
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Country | US
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Telephone | 702-733-9252
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Fax | 702-733-9282
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Provider Business Mailing Address
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Address Line | 2770 S MARYLAND PKWY
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City | LAS VEGAS
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State | NV
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Zip | 89109-1567
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. DORINA BUENAVISTA GRELLA
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Credential |
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Telephone | 702-733-9252
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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 | 3842HHA-5
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License Number State | NV
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