Provider Demographics
NPI:1962942201
Name:HOMEHEALTH MANAGEMENT AND CONSULTANT AGENCY
Entity type:Organization
Organization Name:HOMEHEALTH MANAGEMENT AND CONSULTANT AGENCY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/DPCS
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER JANE
Authorized Official - Middle Name:VERANO
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN, MBA
Authorized Official - Phone:702-929-3416
Mailing Address - Street 1:4495 W. HACIENDA AVE
Mailing Address - Street 2:SUITE 7A
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-1541
Mailing Address - Country:US
Mailing Address - Phone:702-929-3416
Mailing Address - Fax:702-924-7422
Practice Address - Street 1:4495 W. HACIENDA AVE
Practice Address - Street 2:SUITE 7A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-1541
Practice Address - Country:US
Practice Address - Phone:702-929-3416
Practice Address - Fax:702-924-7422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-06
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8670-HHA-0251E00000X
NV8933-HHA-0251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health