MEDICARE: LHCG CLII, 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1528600582
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LHCG CLII, LLC

Provider Business Mailing Address
First Line	:	PO BOX 51266
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70505-1266
Country	:	US
Telephone Number	:	337-233-1307
Fax Number	:	337-233-5764

Provider Business Practice Location Address
First Line	:	3305 SPRING MOUNTAIN RD STE 52
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-8620
Country	:	US
Telephone Number	:	702-570-5818
Fax Number	:	702-570-5828

Authorized Official
Title or Position	:	EXECUTIVE VICE PRESIDENT
Name	:	NICHOLAS GACHASSIN
Credential	:
Telephone Number	:	337-233-1307

Provider Enumeration Date	:	10/11/2019
Last Update Date	:	08/31/2020

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