MEDICARE: NYELLS MEDICAL AND PROFESSIONAL SERVICES

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	91545	NV

General Provider Information

NPI Number	:	1407151830
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NYELLS MEDICAL AND PROFESSIONAL SERVICES

Provider Business Mailing Address
First Line	:	4701 LAWRENCE ST UNIT 1138
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-4200
Country	:	US
Telephone Number	:	702-538-8263
Fax Number	:

Provider Business Practice Location Address
First Line	:	4701 LAWRENCE ST UNIT 1138
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-4200
Country	:	US
Telephone Number	:	702-538-8263
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JACQUELINE CELESS EDWARDS
Credential	:	LAB ASSISTANT/CNA/MA
Telephone Number	:	702-538-8263

Provider Enumeration Date	:	01/15/2011
Last Update Date	:	01/15/2011

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