Basic Information
| Provider Information | |||||||||
| NPI: | 1356303713 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CREEKSIDE HOME HEALTH CARE | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 3675 PECOS MCLEOD | ||||||||
| Address2: | SUITE #500 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891213815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026969229 | ||||||||
| FaxNumber: | 7026961003 | ||||||||
| Practice Location | |||||||||
| Address1: | 3675 PECOS MCLEOD | ||||||||
| Address2: | SUITE #500 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891213815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026969229 | ||||||||
| FaxNumber: | 7026961003 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2006 | ||||||||
| LastUpdateDate: | 04/04/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MONKS | ||||||||
| AuthorizedOfficialFirstName: | JONATHAN | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7026969229 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 297070 | NV | Y | Agencies | Home Health |
No ID Information.