Provider Demographics
NPI:1750460739
Name:DYNAMIC HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:DYNAMIC HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:NISSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PARDO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:818-931-4446
Mailing Address - Street 1:2865 S. JONES
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:39146
Mailing Address - Country:US
Mailing Address - Phone:702-388-7070
Mailing Address - Fax:702-388-2525
Practice Address - Street 1:2865 S. JONES
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:39146
Practice Address - Country:US
Practice Address - Phone:702-388-7070
Practice Address - Fax:702-388-2525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV534HHA-8251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002902114Medicaid
NV297096Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER