NPIMap

Organization Active NPI

Eagle Home Health Agency Inc

  • Home Health Agency
  • Las Vegas, NV
National Provider Identifier
1619355047
Registry record updated May 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
H14-00396 Issued in NV
Legal business name
EAGLE HOME HEALTH AGENCY INC
Practice address
222 S Rainbow Blvd
Suite 202
Las Vegas, NV 89145-5340
Phone
(702) 242-4242
Fax
(702) 242-4243
NPI assigned
May 18, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 18, 2015

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

Authorized official

Name
Helen Austin, RNNPI 1518155951
Title
Administrator
Phone
(702) 242-4242

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X H14-00396 NV Primary

Addresses

Primary practice location

222 S Rainbow Blvd
Suite 202
Las Vegas, NV 89145-5340

Mailing address

222 S Rainbow Blvd
Suite 202
Las Vegas, NV 89145-5340
Phone (702) 242-4242

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160902000057 NV Part A Provider - Home Health Agency 3971899741 Practice locations: Las Vegas, NV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1619355047. Details of each certification follow.

Home health agency certification: CCN 297239

Legal name
EAGLE HOME HEALTH AGENCY INC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jul 12, 2018
Last certification
Jul 12, 2018
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
Sep 16, 2013 in NV
Enrollment address
222 S Rainbow Blvd
Ste 202
Las Vegas, NV 89145-5356
HHA Branch

Care Compare: Home health agency

Medicare Care Compare
Listed as
Eagle Home Health Agency, IncCCN 297239 · All quality measures
Overall star rating
2.5 of 5
Ownership
Proprietary
Certified
Jul 12, 2018
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
29D2154763Eagle Home Health Agency, Inc222 S Rainbow Blvd Ste 202, Las Vegas, NV 89145Certificate of waiverMar 17, 2028

National Provider Directory

National Provider Directory

Locations

222 S Rainbow Blvd
Ste 202
Las Vegas, NV 89145
Phone (702) 242-4242

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
Oghochukwuyem a Ogbanzu Individual 5% Or Greater Direct Ownership InterestCfo/President/Board Membe Jan 1, 2023 100%
Corporate Officer Jan 1, 2023 100%
Corporate DirectorCfo/President/Board Membe Jan 1, 2023 100%
W-2 Managing EmployeeCfo/President/Board Member Jan 1, 2023 100%

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 8

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": "1431907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1431907200000",
    "number": "1619355047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 S RAINBOW BLVD",
            "address_2": "SUITE 202",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891455340",
            "telephone_number": "702-242-4242",
            "fax_number": "702-242-4243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 S RAINBOW BLVD",
            "address_2": "SUITE 202",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891455340",
            "telephone_number": "702-242-4242",
            "fax_number": "702-242-4243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLE HOME HEALTH AGENCY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-18",
        "last_updated": "2015-05-18",
        "status": "A",
        "authorized_official_last_name": "AUSTIN",
        "authorized_official_first_name": "HELEN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "702-242-4242",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NV",
            "license": "H14-00396",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.