MEDICARE: NICKSONHOMES 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	251K00000X	Public Health or Welfare Agency

General Provider Information

NPI Number	:	1346924818
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NICKSONHOMES LLC

Provider Business Mailing Address
First Line	:	2813 PERLITER AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-8707
Country	:	US
Telephone Number	:	702-353-1913
Fax Number	:

Provider Business Practice Location Address
First Line	:	2813 PERLITER AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-8707
Country	:	US
Telephone Number	:	702-353-1913
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. ASHLEY RENEE BUCHANAN-NICKSON
Credential	:
Telephone Number	:	702-353-1913

Provider Enumeration Date	:	06/14/2023
Last Update Date	:	06/14/2023

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Directions to “NICKSONHOMES LLC ” Practice Location

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