Providence Healthcare of Nevada LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

PROVIDENCE HEALTHCARE OF NEVADA LLC

Practice address

5510 S Fort Apache Rd
Ste 18
Las Vegas, NV 89148-7700

Phone

(702) 680-0235

Fax

(702) 680-0236

NPI assigned

May 2, 2017

Organization subpart

No

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

Authorized official

Name

Mr. Gerard M Tabora

Title

Administrator

Phone

(702) 680-0235

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1493683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493683200000",
    "number": "1750817441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5510 S FORT APACHE RD",
            "address_2": "STE 18",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891487700",
            "telephone_number": "702-680-0235",
            "fax_number": "702-680-0236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5510 S FORT APACHE RD",
            "address_2": "STE 18",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891487700",
            "telephone_number": "702-680-0235",
            "fax_number": "702-680-0236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTHCARE OF NEVADA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-02",
        "last_updated": "2017-05-02",
        "status": "A",
        "authorized_official_last_name": "TABORA",
        "authorized_official_first_name": "GERARD",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "702-680-0235",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEVADA SECRETARY OF STATE",
            "identifier": "NV20171115640",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Home Health Agency in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Home Health Agency in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2017; 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.