MEDICARE: HALLOW HANDS HOME CARE LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NV20191365892	OTHER	NV	NEVADA BUSINESS LICENSE

General Provider Information

NPI Number	:	1013573195
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HALLOW HANDS HOME CARE LTD

Provider Business Mailing Address
First Line	:	10954 FREE FLOW PL
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89138-6165
Country	:	US
Telephone Number	:	702-551-5085
Fax Number	:

Provider Business Practice Location Address
First Line	:	3305 SPRING MOUNTAIN RD STE 41
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-8622
Country	:	US
Telephone Number	:	702-551-5085
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. SUSETTE M GILLIAM
Credential	:
Telephone Number	:	702-551-5085

Provider Enumeration Date	:	05/14/2019
Last Update Date	:	05/14/2019

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