Provider Demographics
NPI:1114703444
Name:ST JOHN HOME HEALTH LLC
Entity Type:Organization
Organization Name:ST JOHN HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:POMBUENA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:702-970-7530
Mailing Address - Street 1:3230 S BUFFALO DR STE 107-9
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-2505
Mailing Address - Country:US
Mailing Address - Phone:702-970-7530
Mailing Address - Fax:702-843-0920
Practice Address - Street 1:3230 S BUFFALO DR STE 107
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2506
Practice Address - Country:US
Practice Address - Phone:702-970-7530
Practice Address - Fax:702-843-0920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health