=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992465520
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SBP GROUP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/22/2021
-----------------------------------------------------
Last Update Date | 12/22/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8930 W SUNSET RD STE 340A
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89148-5042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 725-204-8359
-----------------------------------------------------
Fax | 725-251-5195
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8930 W SUNSET RD STE 340A
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89148-5042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 725-251-5928
-----------------------------------------------------
Fax | 725-251-5195
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DON
-----------------------------------------------------
Name | AUTUM KAPINKIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 725-204-8359
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------