Organization Active NPI

Veterans and Seniors Care Management Group

Doing business as Providence Home Health

  • Home Health Agency
  • Las Vegas, NV
National Provider Identifier
1114506193
Registry record updated May 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
VETERANS AND SENIORS CARE MANAGEMENT GROUP
Doing business as
Providence Home Health
Practice address
1064 E Sahara Ave
Las Vegas, NV 89104-3220
Phone
(702) 767-0053
NPI assigned
Apr 6, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 12, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Michael Larouche
Title
President
Phone
(702) 767-0053

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

1064 E Sahara Ave
Las Vegas, NV 89104-3220

Mailing address

1064 E Sahara Ave
Las Vegas, NV 89104-3220
Phone (702) 767-0053

Other names 1

  • PROVIDENCE HOME HEALTH Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210712001035 NV Part A Provider - Home Health Agency 0042612277 Practice locations: Las Vegas, NV

Home health agency certification: CCN 297313

Legal name
VETERANS AND SENIORS CARE MANAGEMENT GROUP
Doing business as
PROVIDENCE HOME HEALTH
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Oct 20, 2021
Last certification
Oct 1, 2021
Organization structure
LLCProprietary
Enrollment address
1064 E Sahara Ave
Ste E
Las Vegas, NV 89104-3220

Care Compare: Home health agency

Medicare Care Compare
Listed as
Providence Home Health LLCCCN 297313 · All quality measures
Ownership
-
Certified
Oct 20, 2021
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Locations

1064 E Sahara Ave
Ste E
Las Vegas, NV 89104
Phone (702) 268-7647

Ownership & related parties

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Lucious Jones Individual 5% Or Greater Direct Ownership InterestOwner May 4, 2024 100%
W-2 Managing EmployeeOwner May 4, 2024 100%

Practitioners & affiliated clinicians

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1617667200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620777600000",
    "number": "1114506193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1064 E SAHARA AVE",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891043220",
            "telephone_number": "702-767-0053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1064 E SAHARA AVE",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891043220",
            "telephone_number": "702-767-0053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VETERANS AND SENIORS CARE MANAGEMENT GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-06",
        "last_updated": "2021-05-12",
        "certification_date": "2021-05-12",
        "status": "A",
        "authorized_official_last_name": "LAROUCHE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "702-767-0053"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PROVIDENCE HOME HEALTH",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PROVIDENCE HOME HEALTH",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.