Provider Demographics
NPI:1639299845
Name:LAS VEGAS HOME HEALTH AGENCY INC
Entity Type:Organization
Organization Name:LAS VEGAS HOME HEALTH AGENCY INC
Other - Org Name:DBA OUR KIDS HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:YELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:YEKTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-433-5368
Mailing Address - Street 1:4160 S PECOS ROAD
Mailing Address - Street 2:SUITE 17
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121
Mailing Address - Country:US
Mailing Address - Phone:702-433-5368
Mailing Address - Fax:702-434-2485
Practice Address - Street 1:4160 S PECOS ROAD
Practice Address - Street 2:SUITE 17
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121
Practice Address - Country:US
Practice Address - Phone:702-433-5368
Practice Address - Fax:702-434-2485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV9005047285Medicaid