Provider Demographics
NPI:1720712235
Name:AVERY HOME HEALTH LLC
Entity Type:Organization
Organization Name:AVERY HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MIRO
Authorized Official - Middle Name:
Authorized Official - Last Name:OBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-416-0611
Mailing Address - Street 1:5660 W FLAMINGO RD STE A
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-2312
Mailing Address - Country:US
Mailing Address - Phone:702-416-0611
Mailing Address - Fax:
Practice Address - Street 1:5660 W FLAMINGO RD STE A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-2312
Practice Address - Country:US
Practice Address - Phone:702-416-0611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-11
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health