NPIMap

Organization Active NPI

Avery Home Health LLC

  • Home Health Agency
  • Las Vegas, NV
National Provider Identifier
1720712235
Registry record updated Jul 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
AVERY HOME HEALTH LLC
Practice address
5660 W Flamingo Rd Ste a
Las Vegas, NV 89103-2312
Phone
(702) 416-0611
NPI assigned
Jul 11, 2022
Last updated
Jul 12, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2022

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

Authorized official

Name
Mr. Miro Oba
Title
Administrator
Phone
(702) 416-0611

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X NU Primary

Addresses

Primary practice location

5660 W Flamingo Rd Ste a
Las Vegas, NV 89103-2312

Mailing address

5660 W Flamingo Rd Ste a
Las Vegas, NV 89103-2312
Phone (702) 416-0611

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220720000180 NV Part A Provider - Home Health Agency 6709267917 Practice locations: Las Vegas, NV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1720712235. Details of each certification follow.

Home health agency certification: CCN 297328

Legal name
AVERY HOME HEALTH LLC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Nov 14, 2022
Last certification
Nov 2, 2022
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Incorporated
Aug 27, 2021 in NV
Enrollment address
5660 W Flamingo Rd
Ste a
Las Vegas, NV 89103-2312

Care Compare: Home health agency

Medicare Care Compare
Listed as
Avery Home Health LLCCCN 297328 · All quality measures
Overall star rating
3 of 5
Ownership
Proprietary
Certified
Nov 14, 2022
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory

Locations

5660 W Flamingo Rd
Ste A
Las Vegas, NV 89103
Phone (702) 365-1743

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Miro Oba Individual Corporate Officer Mar 2, 2022
W-2 Managing Employee Jul 5, 2022
Megan Morano Individual W-2 Managing Employee Jul 5, 2022
Wayne Pastrano Individual 5% Or Greater Direct Ownership Interest Feb 28, 2022 100%
Corporate Officer Feb 28, 2022

Practitioners & affiliated clinicians

Affiliated clinicians 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1657497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657584000000",
    "number": "1720712235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5660 W FLAMINGO RD STE A",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891032312",
            "telephone_number": "702-416-0611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5660 W FLAMINGO RD STE A",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891032312",
            "telephone_number": "702-416-0611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERY HOME HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-11",
        "last_updated": "2022-07-12",
        "certification_date": "2022-07-12",
        "status": "A",
        "authorized_official_last_name": "OBA",
        "authorized_official_first_name": "MIRO",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "702-416-0611",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.