Provider Demographics
NPI:1366977696
Name:NELLIS HOME HEALTH
Entity type:Organization
Organization Name:NELLIS HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSEANNE
Authorized Official - Middle Name:WRIGHT
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-401-1121
Mailing Address - Street 1:455 E TWAIN AVE # 103
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-4928
Mailing Address - Country:US
Mailing Address - Phone:702-401-1121
Mailing Address - Fax:702-733-2897
Practice Address - Street 1:455 E TWAIN AVE # 103
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-4928
Practice Address - Country:US
Practice Address - Phone:702-401-1121
Practice Address - Fax:702-733-2897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVE0308632016-8251300000X, 251C00000X, 251E00000X, 251G00000X, 251K00000X, 251T00000X, 251V00000X, 252Y00000X, 253J00000X, 253Z00000X, 283X00000X, 2865X1600X, 302R00000X, 347C00000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251300000XAgenciesLocal Education Agency (LEA)Group - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No251K00000XAgenciesPublic Health or Welfare
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No251V00000XAgenciesVoluntary or Charitable
No252Y00000XAgenciesEarly Intervention Provider Agency
No253J00000XAgenciesFoster Care Agency
No253Z00000XAgenciesIn Home Supportive Care
No283X00000XHospitalsRehabilitation Hospital
No2865X1600XHospitalsMilitary HospitalMilitary General Acute Care Hospital. Operational (Transportable)
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No347C00000XTransportation ServicesPrivate VehicleGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV=========Medicare Oscar/Certification