Healthcare Provider Details

I. General information

NPI: 1376504779
Provider Name (Legal Business Name): CREEKSIDE HOSPICE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3675 PECOS MCLEOD SUITE 900
LAS VEGAS NV
89121-3815
US

IV. Provider business mailing address

3675 PECOS MCLEOD SUITE 900
LAS VEGAS NV
89121-3815
US

V. Phone/Fax

Practice location:
  • Phone: 702-650-7669
  • Fax: 702-650-7670
Mailing address:
  • Phone: 702-650-7669
  • Fax: 702-650-7670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number3229HPC-7
License Number StateNV

VIII. Authorized Official

Name: MRS. KRISTY DENNERLEIN
Title or Position: ADMINISTRATOR
Credential: RN, BSN, MBNA
Phone: 702-650-7669