Provider Demographics
NPI:1730887860
Name:ELSUBE LLC
Entity type:Organization
Organization Name:ELSUBE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELODIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYNARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-619-1859
Mailing Address - Street 1:417 FOXVALE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-6150
Mailing Address - Country:US
Mailing Address - Phone:170-261-9185
Mailing Address - Fax:702-463-0104
Practice Address - Street 1:417 FOXVALE AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-6150
Practice Address - Country:US
Practice Address - Phone:170-261-9185
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELSUBE LLC DBBA SAN ANTONIO PERSSONAL CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1053748301Medicaid