MEDICARE: HOMETRUST HEALTHCARE, 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	253Z00000X	In Home Supportive Care Agency	7627PCS-0	NV

General Provider Information

NPI Number	:	1750723755
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOMETRUST HEALTHCARE, LLC

Provider Business Mailing Address
First Line	:	4535 W SAHARA AVE STE 211
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-3710
Country	:	US
Telephone Number	:	702-948-8919
Fax Number	:	702-413-7701

Provider Business Practice Location Address
First Line	:	4535 W SAHARA AVE STE 211
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-3710
Country	:	US
Telephone Number	:	702-948-8919
Fax Number	:	702-413-7701

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. CECILIA C LABINPUNO
Credential	:	LPN
Telephone Number	:	702-948-8919

Provider Enumeration Date	:	07/19/2013
Last Update Date	:	07/19/2013

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