Provider Demographics
NPI:1104664028
Name:LAS VEGAS HOME HEALTH PROVIDERS LLC
Entity type:Organization
Organization Name:LAS VEGAS HOME HEALTH PROVIDERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:RACHELLE
Authorized Official - Last Name:FUNTILA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-302-3155
Mailing Address - Street 1:3111 S VALLEY VIEW BLVD STE A217
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-7702
Mailing Address - Country:US
Mailing Address - Phone:702-302-3155
Mailing Address - Fax:
Practice Address - Street 1:3111 S VALLEY VIEW BLVD STE A217
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-7702
Practice Address - Country:US
Practice Address - Phone:702-302-3155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health