MEDICARE: MAYA HEALTHCARE

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

General Provider Information

NPI Number	:	1871031807
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAYA HEALTHCARE

Provider Business Mailing Address
First Line	:	1401 PINE LEAF DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89144-1648
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1401 PINE LEAF DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89144-1648
Country	:	US
Telephone Number	:	702-445-1354
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MOHAMMED AHMED
Credential	:
Telephone Number	:	702-445-1354

Provider Enumeration Date	:	02/10/2017
Last Update Date	:	02/10/2017

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