Healthcare Provider Details

I. General information

NPI: 1316559081
Provider Name (Legal Business Name): PROCARE HOSPICE OF NEVADA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2020
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8025 AMIGO ST
LAS VEGAS NV
89123-1210
US

IV. Provider business mailing address

8025 AMIGO ST
LAS VEGAS NV
89123-1210
US

V. Phone/Fax

Practice location:
  • Phone: 702-380-8300
  • Fax:
Mailing address:
  • Phone: 702-380-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: GREGORY WALSKI
Title or Position: CFO
Credential:
Phone: 702-380-8300