MEDICARE: HOSPICE OF LAS VEGAS, INC.

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	4540HPC-1	NV

General Provider Information

NPI Number	:	1457497539
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOSPICE OF LAS VEGAS, INC.

Provider Business Mailing Address
First Line	:	5765 S RAINBOW BLVD
Second Line	:	SUITE 111
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-2536
Country	:	US
Telephone Number	:	702-853-9063
Fax Number	:

Provider Business Practice Location Address
First Line	:	5765 S RAINBOW BLVD
Second Line	:	SUITE 111
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-2536
Country	:	US
Telephone Number	:	702-853-9063
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR, SECRETARY
Name	:	MRS. APRIL LYNN SULLIVAN
Credential	:
Telephone Number	:	702-853-9063

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	04/26/2013

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