Provider Demographics
NPI:1205574944
Name:BLESSED TRICARE HOME HEALTH LLC
Entity type:Organization
Organization Name:BLESSED TRICARE HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:GLORIOSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-815-4106
Mailing Address - Street 1:3430 E FLAMINGO RD STE 244
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-5020
Mailing Address - Country:US
Mailing Address - Phone:702-989-1856
Mailing Address - Fax:
Practice Address - Street 1:3430 E FLAMINGO RD STE 244
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5020
Practice Address - Country:US
Practice Address - Phone:702-989-1856
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-23
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health