MEDICARE: LAS VEGAS MARK LLC

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1295627750
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAS VEGAS MARK LLC

Provider Business Mailing Address
First Line	:	10845 GRIFFITH PEAK DR STE 2-115
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-1553
Country	:	US
Telephone Number	:	216-925-2430
Fax Number	:

Provider Business Practice Location Address
First Line	:	10845 GRIFFITH PEAK DR STE 2-115
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-1553
Country	:	US
Telephone Number	:	216-925-2430
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARK J NAGLE
Credential	:
Telephone Number	:	216-925-2430

Provider Enumeration Date	:	07/18/2025
Last Update Date	:	07/18/2025

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