- Enrollment id
- O20250522000952
- Enrollment state
- NV
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1346057882
- Multiple npi flag
- N
- Ccn
- 297395
- Associate id
- 3072032044
- Organization name
- PRIME HEALTHCARE OF NEVADA LLC
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 6787 W TROPICANA AVE
- Address line 2
- STE 257
- City
- LAS VEGAS
- State
- NV
- Zip code
- 891034912