MEDICARE: COMPASSIONATE CARE MEDICAL CENTER 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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
2	363LP2300X	Primary Care Nurse Practitioner

General Provider Information

NPI Number	:	1679421945
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPASSIONATE CARE MEDICAL CENTER LLC

Provider Business Mailing Address
First Line	:	304 S JONES BLVD # 128
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-2623
Country	:	US
Telephone Number	:	725-888-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	408 VILLA ESPANA WAY
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-2805
Country	:	US
Telephone Number	:	725-888-3000
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	ANDRIA HENDERSON
Credential	:	NP
Telephone Number	:	725-888-3000

Provider Enumeration Date	:	03/20/2026
Last Update Date	:	03/23/2026

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