MEDICARE: VANDA'S NEWLIFE CARE SERVICES 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	:	1568045755
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VANDA'S NEWLIFE CARE SERVICES LLC

Provider Business Mailing Address
First Line	:	7320 S RAINBOW BLVD STE 102-559
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-0406
Country	:	US
Telephone Number	:	800-705-5043
Fax Number	:

Provider Business Practice Location Address
First Line	:	7320 S RAINBOW BLVD STE 102-559
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-0406
Country	:	US
Telephone Number	:	800-705-5043
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. CALVETTA LAQUITA BRUTON
Credential	:
Telephone Number	:	702-426-6886

Provider Enumeration Date	:	05/04/2021
Last Update Date	:	11/26/2021

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