- Enrollment id
- O20170905001154
- Enrollment state
- NV
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1124577127
- Multiple npi flag
- N
- Ccn
- 297233
- Associate id
- 5890068357
- Organization name
- MELO HEALTH SYSTEMS LLC
- Doing business as name
- EXECUTIVE CARE HOME HEALTH
- Incorporation date
- 2015-10-16
- Incorporation state
- NV
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 1771 E FLAMINGO RD
- Address line 2
- STE 119B
- City
- LAS VEGAS
- State
- NV
- Zip code
- 891190839
- Practice location type
- HHA BRANCH