MEDICARE: COMPASSION CREST LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency	7898PCS-0	NV

General Provider Information

NPI Number	:	1003293937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPASSION CREST LLC

Provider Business Mailing Address
First Line	:	1312 S 8TH ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-1638
Country	:	US
Telephone Number	:	702-385-0920
Fax Number	:	702-474-6340

Provider Business Practice Location Address
First Line	:	2551 S FORT APACHE RD STE 102
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-8700
Country	:	US
Telephone Number	:	702-385-0920
Fax Number	:	702-518-6220

Authorized Official
Title or Position	:	ADMINISTRATOR/CEO
Name	:	MR. PAUL BUTTERFIELD
Credential	:
Telephone Number	:	702-385-0920

Provider Enumeration Date	:	04/29/2015
Last Update Date	:	12/30/2022

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