MEDICARE: NEVADA COMMUNITY HOSPICE 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	251G00000X	Community Based Hospice Care Agency	7778-HPC	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235577719
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEVADA COMMUNITY HOSPICE LLC

Provider Business Mailing Address
First Line	:	2430 W RAY RD STE 3
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85224-3552
Country	:	US
Telephone Number	:	480-383-8599
Fax Number	:	480-398-1620

Provider Business Practice Location Address
First Line	:	2764 LAKE SAHARA DR STE 113
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-3400
Country	:	US
Telephone Number	:	702-605-9959
Fax Number	:	702-605-9960

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RICHARD E BASS
Credential	:
Telephone Number	:	602-717-4751

Provider Enumeration Date	:	06/06/2013
Last Update Date	:	05/16/2022

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