- Enrollment id
- O20241231001491
- Enrollment state
- NV
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1104646215
- Multiple npi flag
- N
- Ccn
- 297380
- Associate id
- 5991232035
- Organization name
- HOLY TRINITY HOME HEALTH LLC
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 1641 E FLAMINGO RD
- Address line 2
- STE 13B
- City
- LAS VEGAS
- State
- NV
- Zip code
- 891195257
- Practice location type
- HHA BRANCH