Active NPI
Veterans and Seniors Care Management Group
Doing business as Providence Home Health
- Home Health Agency
- Las Vegas, NV
National Provider Identifier
1114506193
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Agency
- 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
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) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NV
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
- LLC
- 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 LLC
- Ownership
- -
- Certified
- Oct 20, 2021
- Medicare certification status
- Active
National Provider Directory
National Provider DirectoryLocations
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.
| Name | Role | Since | Share |
|---|---|---|---|
| Lucious Jones | 5% Or Greater Direct Ownership Interest | May 4, 2024 | 100% |
| W-2 Managing Employee | May 4, 2024 | 100% |
Practitioners & affiliated clinicians
Affiliated clinicians 1
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Family Nurse Practitioner
- Las Vegas, NV
- NPI 1295325785
Home health agency
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.