Provider Demographics
NPI:1902132954
Name:MOUNTAIN CREST HOME HEALTH, LLC
Entity Type:Organization
Organization Name:MOUNTAIN CREST HOME HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NONA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUTISTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-785-0128
Mailing Address - Street 1:10501 W GOWAN RD STE 170
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-6603
Mailing Address - Country:US
Mailing Address - Phone:702-785-0128
Mailing Address - Fax:702-785-0127
Practice Address - Street 1:10501 W GOWAN RD STE 170
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-6603
Practice Address - Country:US
Practice Address - Phone:702-785-0128
Practice Address - Fax:702-785-0127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-27
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health