MEDICARE: CREST POINT HOME HEALTH 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1518558113
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CREST POINT HOME HEALTH LLC

Provider Business Mailing Address
First Line	:	4129 JUANITA MAY AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-8951
Country	:	US
Telephone Number	:	702-984-8377
Fax Number	:	725-204-7069

Provider Business Practice Location Address
First Line	:	4129 JUANITA MAY AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-8951
Country	:	US
Telephone Number	:	702-984-8377
Fax Number	:	725-204-7069

Authorized Official
Title or Position	:	ADMINISTRATOR, RN
Name	:	OKECHUKWU PRINCE ETONIRU
Credential	:
Telephone Number	:	702-984-8377

Provider Enumeration Date	:	01/27/2021
Last Update Date	:	06/15/2021

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Directions to “CREST POINT HOME HEALTH LLC ” Practice Location

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