Canyon Nevada LLC
Organization Active NPI Home Health Agency · Laughlin, NV
NPI 1558909390 · NPPES record last updated May 9, 2025
Key facts
- NPI
- 1558909390
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Home Health Agency 251E00000X
- Legal business name
- CANYON NEVADA LLC
- Practice address
- 3100 S Needles Hwy Ste 500
Laughlin, NV 89029-0815 - Phone
- (702) 868-1400
- Fax
- (702) 720-1423
- NPI assigned
- Dec 11, 2019
- Organization subpart
- No
Authorized official
- Name
- Breezie Liskey
- Title
- VP of Operations
- Phone
- (801) 456-7874
Owners & managing parties with NPI records 2
Other NPIs with the same Medicare PAC ID 1
Corporate family (same tax ID) 1
Member of 1
Facilities with the same owner 9
Practitioners 58
-
Tammy Ahler, RN
-
Tina Bird, CNA
-
Cindy Bishop, CNA
-
Gigi Bouchard, RN
-
Alexandria Breitkopf, CNA
-
Shari Brewer, CNA
-
Kayla Brock, RN
-
Stevie Brown, RN
-
Sherri L Church, RN
-
Rodney S Clousing, OTA
-
Bonnie Corley, RN
-
Samantha Edwards, RN
-
Jackelin Estrada, LPN
-
Jacqueline Flores, CNA
-
Betty Garrett, RN
-
Jennifer Gerali, RN
-
Gina Gillespie, RN
-
Carol Girton, RN
-
Lynn Jones, RN
-
Charles Jordan, OTA
-
Ann Kasik, LSW
-
Chloe Labriola, RN
-
Brenda Lee, RN
-
Sierra Madsen, RN
Affiliated clinicians 6
-
Donna L Kelly, NP-C
-
Catherine King, APN
-
Alene Davis Marrott, FNP-C
-
Kanwaldeep Kaur Virk, M.D.
Medicare Care Compare: Home health agency
- Listed as
- Canyon Home Care & Hospice
- Overall star rating
- ★★★★★ 4.5 of 5
- Ownership
- -
- Certified
- Jun 30, 2022
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NV
Home health agency certification: CCN 297323
- Legal name
- CANYON NEVADA LLC
- Doing business as
- CANYON HOME CARE & HOSPICE
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Jun 30, 2022
- Last certification
- Jun 16, 2022
- Organization structure
- LLC · Proprietary
- Incorporated
- May 9, 2017 in NV
- Enrollment address
- 3100 Needles Hwy
Ste 500
Laughlin, NV 89029-0815
All disclosed owners & managing parties 5
| Name | Role | Since | Share |
|---|---|---|---|
| Orange Healthcare, LLC |
5% Or Greater Indirect Ownership Interest | Jan 1, 2020 | 50% |
| Kenneth Edwin Norris |
5% Or Greater Indirect Ownership Interest | Jan 1, 2020 | 50% |
| Operational/Managerial Control |
Jan 1, 2020 | 100% | |
| Tyson Cichos |
5% Or Greater Indirect Ownership Interest | Jan 1, 2020 | 25% |
| Cory R Robison |
5% Or Greater Indirect Ownership Interest | Jan 1, 2020 | 25% |
| Home Caregivers Partnership, LLC |
5% Or Greater Direct Ownership Interest | Jan 1, 2020 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200508001952 | NV | Part a Provider - Home Health Agency | 0648543462 | Practice locations: Laughlin, NV; Mesquite, NV |
National Provider Directory
- Tax ID family
- Canyon Home Care
Locations
400 Shadow Ln
Ste 210
Las Vegas, NV 89106
Phone (480) 843-9877
3100 S Needles Hwy
Ste 500
Laughlin, NV 89029
Phone (702) 703-1262
3100 S Needles Hwy
Ste 600
Laughlin, NV 89029
Phone (702) 868-1400
786 W Pioneer Blvd
Ste 104
Mesquite, NV 89027
Phone (702) 897-9566
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | Yes |
Addresses
Primary practice location
3100 S Needles Hwy Ste 500
Laughlin, NV 89029-0815
Mailing address
746 E Winchester St Ste 200
Salt Lake City, UT 84107-8513
Phone (801) 485-6166
Other practice location 1
786 W Pioneer Blvd Ste 104
Mesquite, NV 89027-8888
Phone (702) 897-9566
Other names
- Canyon Home Care
Other providers in Laughlin, NV
- Kayla Brock
- Stevie Brown
- Bullhead City Clinic Corp
- Leanna Burk
- Heidi Callahan
- Canyon Nevada LLC
- Jiann Choo
- Sherri L Church
- Rodney S Clousing
- Community Birth Group
All providers in Laughlin, NV · Home Health Agency in Nevada
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 9, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.