MEDICARE: WELLCARE HOME HEALTH INC.

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	6304HHA	NV

General Provider Information

NPI Number	:	1851639132
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLCARE HOME HEALTH INC.

Provider Business Mailing Address
First Line	:	3110 S VALLEY VIEW BLVD STE 204
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-8389
Country	:	US
Telephone Number	:	702-476-3394
Fax Number	:	702-733-6029

Provider Business Practice Location Address
First Line	:	3110 S VALLEY VIEW BLVD STE 204
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-8389
Country	:	US
Telephone Number	:	702-476-3394
Fax Number	:	702-733-6029

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. LUZ SUENO
Credential	:	R.N.
Telephone Number	:	702-476-3394

Provider Enumeration Date	:	01/22/2013
Last Update Date	:	09/26/2013

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