Healthcare Provider Details

I. General information

NPI: 1952698151
Provider Name (Legal Business Name): 702 HOSPICE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2011
Last Update Date: 01/13/2023
Certification Date: 01/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 SPRING MOUNTAIN RD 40
LAS VEGAS NV
89102-8609
US

IV. Provider business mailing address

3305 SPRING MOUNTAIN RD STE 40
LAS VEGAS NV
89102-8622
US

V. Phone/Fax

Practice location:
  • Phone: 702-534-7840
  • Fax:
Mailing address:
  • Phone: 702-534-7840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MIKE WANG
Title or Position: PRESIDENT
Credential:
Phone: 702-534-7840