Provider Demographics
NPI:1891706610
Name:HOME HEALTH INFUSION, INC.
Entity Type:Organization
Organization Name:HOME HEALTH INFUSION, INC.
Other - Org Name:SOUTHERN NEVADA HOME INFUSION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:G
Authorized Official - Last Name:LAST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-673-8666
Mailing Address - Street 1:145 E RENO AVE STE E8
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-1114
Mailing Address - Country:US
Mailing Address - Phone:702-254-7100
Mailing Address - Fax:702-254-9016
Practice Address - Street 1:145 E RENO AVE STE E8
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-1114
Practice Address - Country:US
Practice Address - Phone:702-254-7100
Practice Address - Fax:702-254-9016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPH010833336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2905973OtherNABP NUMBER
UT6264299-8913OtherUTAH CONTROLLED SUBST LIC
UT6264299-1708OtherUTAH PHARMACY - CLASS D
UT6264299-1708OtherUTAH PHARMACY - CLASS D