Provider Demographics
NPI:1740730829
Name:HEALTHY LIVING AT HOME - LAS VEGAS LLC
Entity type:Organization
Organization Name:HEALTHY LIVING AT HOME - LAS VEGAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-260-5296
Mailing Address - Street 1:6623 LAS VEGAS BLVD S UNIT 220
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-2603
Mailing Address - Country:US
Mailing Address - Phone:702-735-6209
Mailing Address - Fax:702-735-6210
Practice Address - Street 1:38 S WATER ST
Practice Address - Street 2:SUITE 100
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-7324
Practice Address - Country:US
Practice Address - Phone:702-735-6209
Practice Address - Fax:702-735-6210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-12
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health