Provider Demographics
NPI:1811174196
Name:MESA VIEW HOME CARE, LLC
Entity type:Organization
Organization Name:MESA VIEW HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TY
Authorized Official - Middle Name:S
Authorized Official - Last Name:WAKEFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:702-346-2460
Mailing Address - Street 1:PO BOX 1887
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:NV
Mailing Address - Zip Code:89024-1887
Mailing Address - Country:US
Mailing Address - Phone:702-346-2460
Mailing Address - Fax:702-346-2466
Practice Address - Street 1:330 FALCON RIDGE PKWY STE 200
Practice Address - Street 2:SUITE A
Practice Address - City:MESQUITE
Practice Address - State:NV
Practice Address - Zip Code:89027-8881
Practice Address - Country:US
Practice Address - Phone:702-346-2460
Practice Address - Fax:702-346-2466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV297160Medicare Oscar/Certification