=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720437486
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DEDICATED HOSPICE CARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2016
-----------------------------------------------------
Last Update Date | 06/08/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2780 S JONES BLVD STE 215
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89146-5659
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-405-0902
-----------------------------------------------------
Fax | 702-405-0910
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2780 S JONES BLVD STE 215
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89146-5659
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-405-0902
-----------------------------------------------------
Fax | 702-405-0910
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ROZA SPARTALIAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 702-405-0902
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number | NV20161239330
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------