MEDICARE: LAS VEGAS HEALTH SYSTEM 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	5512HHA-0	NV

General Provider Information

NPI Number	:	1861621013
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAS VEGAS HEALTH SYSTEM LLC

Provider Business Mailing Address
First Line	:	3111 S VALLEY VIEW BLVD
Second Line	:	SUITE A-216
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-8317
Country	:	US
Telephone Number	:	702-259-0036
Fax Number	:	702-259-0069

Provider Business Practice Location Address
First Line	:	3111 S VALLEY VIEW BLVD
Second Line	:	SUITE A216
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-8317
Country	:	US
Telephone Number	:	702-259-0036
Fax Number	:	702-259-0069

Authorized Official
Title or Position	:	CEO
Name	:	MRS. MARIA GRACIA V RETRATO
Credential	:
Telephone Number	:	702-259-0036

Provider Enumeration Date	:	07/09/2009
Last Update Date	:	07/09/2009

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