MEDICARE: MESA VIEW HOME CARE, 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		NV

General Provider Information

NPI Number	:	1811174196
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MESA VIEW HOME CARE, LLC

Provider Business Mailing Address
First Line	:	PO BOX 1887
Second Line	:
City	:	MESQUITE
State	:	NV
Zip	:	89024-1887
Country	:	US
Telephone Number	:	702-346-2460
Fax Number	:	702-346-2466

Provider Business Practice Location Address
First Line	:	330 FALCON RIDGE PKWY STE 200
Second Line	:	SUITE A
City	:	MESQUITE
State	:	NV
Zip	:	89027-8881
Country	:	US
Telephone Number	:	702-346-2460
Fax Number	:	702-346-2466

Authorized Official
Title or Position	:	CEO/MEMBER
Name	:	TY S. WAKEFIELD
Credential	:	MSPT
Telephone Number	:	702-346-2460

Provider Enumeration Date	:	01/29/2008
Last Update Date	:	01/23/2014

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