Provider Demographics
NPI:1023326691
Name:EXCLUSIVE HOME HEALTHCARE
Entity type:Organization
Organization Name:EXCLUSIVE HOME HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KIKHELA
Authorized Official - Middle Name:PAPY
Authorized Official - Last Name:TSASA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-813-9827
Mailing Address - Street 1:1101 N DECATUR BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-1220
Mailing Address - Country:US
Mailing Address - Phone:702-813-9827
Mailing Address - Fax:702-642-4372
Practice Address - Street 1:1101 N DECATUR BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-1220
Practice Address - Country:US
Practice Address - Phone:702-813-9827
Practice Address - Fax:702-642-4372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-17
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV20101385764251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health