MEDICARE: LAS VEGAS HOME HEALTH AGENCY

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	251B00000X	Case Management Agency
2	251S00000X	Community/Behavioral Health Agency	GF-125401000-0006	NV

General Provider Information

NPI Number	:	1023288446
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAS VEGAS HOME HEALTH AGENCY

Provider Business Mailing Address
First Line	:	4160 S PECOS RD STE 17
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5027
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4160 S PECOS RD STE 17
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5027
Country	:	US
Telephone Number	:	702-433-5368
Fax Number	:

Authorized Official
Title or Position	:	CASE MANAGER
Name	:	MRS. HEATHER LONG
Credential	:
Telephone Number	:	702-433-5368

Provider Enumeration Date	:	03/03/2008
Last Update Date	:	03/03/2008

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