Provider Demographics
NPI:1356303713
Name:CREEKSIDE HOME HEALTH CARE
Entity type:Organization
Organization Name:CREEKSIDE HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:MONKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-696-9229
Mailing Address - Street 1:3675 PECOS MCLEOD
Mailing Address - Street 2:SUITE #500
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-3815
Mailing Address - Country:US
Mailing Address - Phone:702-696-9229
Mailing Address - Fax:702-696-1003
Practice Address - Street 1:3675 PECOS MCLEOD
Practice Address - Street 2:SUITE #500
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-3815
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:2006-04-03
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV297070251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV297070Medicare ID - Type UnspecifiedMEDICARE LICENSE