Provider Demographics
NPI:1962890673
Name:BAILEY, IDELL (OWNER)
Entity type:Individual
Prefix:
First Name:IDELL
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N RAINBOW BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-1061
Mailing Address - Country:US
Mailing Address - Phone:702-305-5377
Mailing Address - Fax:855-710-6639
Practice Address - Street 1:500 N RAINBOW BLVD STE 300
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-1061
Practice Address - Country:US
Practice Address - Phone:702-305-5377
Practice Address - Fax:855-710-6639
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-03
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20141084923374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide