Provider Demographics
NPI:1336108810
Name:NATIVE HOME HEALTH CARE, LLC
Entity Type:Organization
Organization Name:NATIVE HOME HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:702-862-4177
Mailing Address - Street 1:2235 E FLAMINGO RD
Mailing Address - Street 2:SUITE C-7
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5129
Mailing Address - Country:US
Mailing Address - Phone:702-862-4177
Mailing Address - Fax:702-862-4185
Practice Address - Street 1:2235 E FLAMINGO RD
Practice Address - Street 2:SUITE C-7
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5129
Practice Address - Country:US
Practice Address - Phone:702-862-4177
Practice Address - Fax:702-862-4185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV116513302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100504839Medicaid