=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689207649
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SILVER STATE HOSPICE CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2020
-----------------------------------------------------
Last Update Date | 08/04/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1771 E FLAMINGO RD STE 120A
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89119-0837
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-825-4500
-----------------------------------------------------
Fax | 702-608-8792
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1771 E FLAMINGO RD STE 120A
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89119-0837
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-825-4500
-----------------------------------------------------
Fax | 702-608-8792
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | OU LEE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 702-825-4500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------