MEDICARE: EXCLUSIVE HOME HEALTHCARE

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	20101385764	NV

General Provider Information

NPI Number	:	1023326691
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXCLUSIVE HOME HEALTHCARE

Provider Business Mailing Address
First Line	:	1101 N DECATUR BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-1220
Country	:	US
Telephone Number	:	702-813-9827
Fax Number	:	702-642-4372

Provider Business Practice Location Address
First Line	:	1101 N DECATUR BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-1220
Country	:	US
Telephone Number	:	702-813-9827
Fax Number	:	702-642-4372

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. KIKHELA PAPY TSASA
Credential	:
Telephone Number	:	702-813-9827

Provider Enumeration Date	:	09/17/2010
Last Update Date	:	03/10/2017

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