Provider Demographics
NPI:1043559248
Name:MESA VIEW HOME CARE
Entity Type:Organization
Organization Name:MESA VIEW HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TY
Authorized Official - Middle Name:S
Authorized Official - Last Name:WAKEFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:702-346-2460
Mailing Address - Street 1:330 FALCON RIDGE PKWY
Mailing Address - Street 2:BUILDING 200 STE A
Mailing Address - City:MESQUITE
Mailing Address - State:NV
Mailing Address - Zip Code:89027-8877
Mailing Address - Country:US
Mailing Address - Phone:702-346-2460
Mailing Address - Fax:702-346-2466
Practice Address - Street 1:330 FALCON RIDGE PKWY
Practice Address - Street 2:BUILDING 200 STE A
Practice Address - City:MESQUITE
Practice Address - State:NV
Practice Address - Zip Code:89027-8877
Practice Address - Country:US
Practice Address - Phone:702-346-2460
Practice Address - Fax:702-346-2466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7402PCS-0253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care