Organization
MADEA HOUSE LLC
Active
Other names
Madea House
Organization subpart
No
Provider details
NPI number
Authorized official
ANDRE HUGHES (MEMBER)
(702) 505-0330
Entity
Organization
Contact information
Practice address
903 ROYALMILE WAY, NORTH LAS VEGAS, NV 89032-9001
(702) 488-1472
(702) 816-2990
Mailing address
903 ROYALMILE WAY, NORTH LAS VEGAS, NV 89032-9001
(702) 488-1472
(702) 816-2990
Taxonomy
Speciality
Code
Description
License number
State
174200000X
Meals Provider
1235576323
NV
251B00000X
Case Management Agency
Primary
1235576323
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1235576323
—
NV
05
—
1669778213
—
NV
Enumeration date
06/13/2017
Last updated
07/21/2022
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