=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003370677
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FIRST CHOICE HOSPICE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2019
-----------------------------------------------------
Last Update Date | 03/29/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3920 E PATRICK LN # 100
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89120-3927
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-576-0495
-----------------------------------------------------
Fax | 705-576-0496
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3920 E PATRICK LN # 100
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89120-3927
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-576-0495
-----------------------------------------------------
Fax | 705-576-0496
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MICHAEL THOMAS CLEGG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 702-576-0495
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------