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General NPI Number Information
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NPI Number | 1922520675
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Entity Type | Organization
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Legal Business Name | CANYON NEVADA LLC
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Dates
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Enumeration Date | 07/14/2017
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Last Update Date | 05/09/2025
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Provider Practice Location Address
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Address Line | 3100 S NEEDLES HWY STE 500
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City | LAUGHLIN
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State | NV
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Zip | 89029-0815
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Country | US
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Telephone | 702-868-1400
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Fax | 702-720-1423
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Provider Business Mailing Address
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Address Line | 746 E WINCHESTER ST STE 200
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City | SALT LAKE CITY
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State | UT
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Zip | 84107-8513
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Country | US
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Telephone | 801-485-6166
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Fax | 801-531-1949
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Authorized Official
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Title or Position | VP OF OPERATIONS
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Name | BREEZIE LISKEY
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Credential |
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Telephone | 801-456-7874
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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