Provider Demographics
NPI:1578617387
Name:NEVADA DESERT HOME HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:NEVADA DESERT HOME HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KEAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:818-974-2676
Mailing Address - Street 1:4170 S DECATUR BLVD STE D6
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-6815
Mailing Address - Country:US
Mailing Address - Phone:702-222-3911
Mailing Address - Fax:702-220-3911
Practice Address - Street 1:4170 S DECATUR BLVD STE D6
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-6815
Practice Address - Country:US
Practice Address - Phone:702-222-3911
Practice Address - Fax:702-220-3911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4593HHA-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV297177Medicare Oscar/Certification