Madea House LLC

Primary specialty

Case Management AgencyTaxonomy code 251B00000X

License

1235576323 Issued in NV

Legal business name

MADEA HOUSE LLC

Practice address

903 Royalmile Way
North Las Vegas, NV 89032-9001

Phone

(702) 488-1472

Fax

(702) 816-2990

NPI assigned

Jun 13, 2017

Organization subpart

No

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

Authorized official

Name

Andre Hughes

Title

Member

Phone

(702) 505-0330

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Madea House Doing business as

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

{
    "created_epoch": "1497312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1750811840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "903 ROYALMILE WAY",
            "city": "NORTH LAS VEGAS",
            "state": "NV",
            "postal_code": "890329001",
            "telephone_number": "702-488-1472",
            "fax_number": "702-816-2990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "903 ROYALMILE WAY",
            "city": "NORTH LAS VEGAS",
            "state": "NV",
            "postal_code": "890329001",
            "telephone_number": "702-488-1472",
            "fax_number": "702-816-2990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MADEA HOUSE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-13",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "HUGHES",
        "authorized_official_first_name": "ANDRE",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "702-505-0330"
    },
    "taxonomies": [
        {
            "code": "174200000X",
            "taxonomy_group": "",
            "desc": "Meals",
            "state": "NV",
            "license": "1235576323",
            "primary": false
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "NV",
            "license": "1235576323",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1235576323",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1669778213",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Madea House",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tracey Lee Mackenzie, BST
• Isaiah William Mackey
• Lori Macon
• Anthony Madden
• Laveina Maddox
• Breagan Madejek
• Ruheena Madhura, NP
• Alec Jansen Carandang Madriaga, PHARMD
• Jayson Madriaga, O.D.
• Gilbert R. Madrid, LMFT, LADC

• Case Management Agency in North Las Vegas, NV
• Providers in North Las Vegas, NV by specialty
• Case Management Agency in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.