Provider Demographics
NPI:1073662185
Name:CHISAL ENTERPRISES, INC.
Entity Type:Organization
Organization Name:CHISAL ENTERPRISES, INC.
Other - Org Name:CHISAL HOME HEALTH AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:A
Authorized Official - Last Name:BASILIO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:702-898-2212
Mailing Address - Street 1:6230 MCLEOD DR
Mailing Address - Street 2:SUITE #100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-4442
Mailing Address - Country:US
Mailing Address - Phone:702-898-2212
Mailing Address - Fax:
Practice Address - Street 1:6230 MCLEOD DR
Practice Address - Street 2:SUITE #100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-4442
Practice Address - Country:US
Practice Address - Phone:702-898-2212
Practice Address - Fax:702-898-2201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4584HHA-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV4584HHA-1OtherNV STATE BLC LICENSE