Provider Demographics
NPI:1306061080
Name:ST MARY'S HOME HEALTH CARE INC
Entity type:Organization
Organization Name:ST MARY'S HOME HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELITA
Authorized Official - Middle Name:MAGSANOC
Authorized Official - Last Name:BALUYUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-248-6900
Mailing Address - Street 1:5000 W OAKEY BLVD
Mailing Address - Street 2:SUITE A6
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-3393
Mailing Address - Country:US
Mailing Address - Phone:702-248-6900
Mailing Address - Fax:702-258-7301
Practice Address - Street 1:5000 W OAKEY BLVD
Practice Address - Street 2:SUITE A6
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-3393
Practice Address - Country:US
Practice Address - Phone:702-248-6900
Practice Address - Fax:702-258-7301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4599HHA1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV297132Medicare Oscar/Certification