Provider Demographics
NPI:1942528492
Name:CREEKSIDE HOME CARE II, LLC
Entity Type:Organization
Organization Name:CREEKSIDE HOME CARE II, LLC
Other - Org Name:COMPASSUS HOME HEALTH LAS VEGAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-425-5418
Mailing Address - Street 1:10 CADILLAC DRIVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-1001
Mailing Address - Country:US
Mailing Address - Phone:615-377-7022
Mailing Address - Fax:615-373-4457
Practice Address - Street 1:3530 E FLAMINGO RD
Practice Address - Street 2:SUITE 270
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5069
Practice Address - Country:US
Practice Address - Phone:702-696-9229
Practice Address - Fax:702-696-1003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-07
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV530HHA-23251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
297070Medicare Oscar/Certification