Provider Demographics
NPI:1417592221
Name:FRONTLINERS HOME HEALTH OF LAS VEGAS,LLC
Entity Type:Organization
Organization Name:FRONTLINERS HOME HEALTH OF LAS VEGAS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GWENDOLYN MAY
Authorized Official - Middle Name:
Authorized Official - Last Name:HERODICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-956-7626
Mailing Address - Street 1:7528 FONTERA CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-6310
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7528 FONTERA CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89139-6310
Practice Address - Country:US
Practice Address - Phone:928-292-9012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-15
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care