=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154009827
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOLLISTIC HOSPICE OF LAS VEGAS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2023
-----------------------------------------------------
Last Update Date | 11/21/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8987 W FLAMINGO RD, BLDG 105 SUITE N 103
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89147-0437
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-550-0177
-----------------------------------------------------
Fax | 702-551-5102
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8987 WEST FLAMINGO ROAD, BLDG 105, SUITE N 103
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89147-0437
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-635-7443
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | ABRAHAM PULIA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 702-635-7443
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------