Provider Demographics
NPI:1518558113
Name:CREST POINT HOME HEALTH LLC
Entity type:Organization
Organization Name:CREST POINT HOME HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR, RN
Authorized Official - Prefix:
Authorized Official - First Name:OKECHUKWU
Authorized Official - Middle Name:PRINCE
Authorized Official - Last Name:ETONIRU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-984-8377
Mailing Address - Street 1:4129 JUANITA MAY AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-8951
Mailing Address - Country:US
Mailing Address - Phone:702-984-8377
Mailing Address - Fax:725-204-7069
Practice Address - Street 1:4129 JUANITA MAY AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-8951
Practice Address - Country:US
Practice Address - Phone:702-984-8377
Practice Address - Fax:725-204-7069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-27
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health