=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235533597
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAZMINE ENTERPRISES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2014
-----------------------------------------------------
Last Update Date | 10/01/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2950 E FLAMINGO RD SUITE K
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89121-5209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-750-0212
-----------------------------------------------------
Fax | 702-750-0242
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2950 E FLAMINGO RD SUITE K
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89121-5209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-750-0212
-----------------------------------------------------
Fax | 702-750-0242
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | JENNIFER BASILIO
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 702-750-0212
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------