MEDICARE: CHARMED HOME HEALTH 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	314000000X	Skilled Nursing Facility	1007715014	NV

General Provider Information

NPI Number	:	1730326224
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARMED HOME HEALTH CARE SERVICES LLC

Provider Business Mailing Address
First Line	:	6201 E LAKE MEAD BLVD
Second Line	:	UNIT 104
City	:	LAS VEGAS
State	:	NV
Zip	:	89156-6990
Country	:	US
Telephone Number	:	702-438-5335
Fax Number	:	702-438-5335

Provider Business Practice Location Address
First Line	:	6201 E LAKE MEAD BLVD
Second Line	:	UNIT 104
City	:	LAS VEGAS
State	:	NV
Zip	:	89156-6990
Country	:	US
Telephone Number	:	702-438-5335
Fax Number	:	702-438-5335

Authorized Official
Title or Position	:	OWNER/CARE GIVER
Name	:	MRS. JENNIFER JO MATTIO KATSORIS
Credential	:
Telephone Number	:	702-426-5959

Provider Enumeration Date	:	01/21/2009
Last Update Date	:	01/21/2009

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