MEDICARE: HOLLISTIC HOSPICE OF LAS VEGAS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1154009827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLLISTIC HOSPICE OF LAS VEGAS LLC

Provider Business Mailing Address
First Line	:	8987 WEST FLAMINGO ROAD, BLDG 105, SUITE N 103
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-0437
Country	:	US
Telephone Number	:	702-635-7443
Fax Number	:

Provider Business Practice Location Address
First Line	:	8987 W FLAMINGO RD, BLDG 105 SUITE N 103
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-0437
Country	:	US
Telephone Number	:	702-550-0177
Fax Number	:	702-551-5102

Authorized Official
Title or Position	:	CEO
Name	:	ABRAHAM PULIA
Credential	:
Telephone Number	:	702-635-7443

Provider Enumeration Date	:	07/11/2023
Last Update Date	:	11/21/2024

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