MEDICARE: PHHC OF NEVADA 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

General Provider Information

NPI Number	:	1336870039
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHHC OF NEVADA LLC

Provider Business Mailing Address
First Line	:	3087 E WARM SPRINGS RD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3754
Country	:	US
Telephone Number	:	702-476-9684
Fax Number	:	702-476-9698

Provider Business Practice Location Address
First Line	:	3161 E WARM SPRINGS RD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3144
Country	:	US
Telephone Number	:	702-476-9684
Fax Number	:	702-476-9698

Authorized Official
Title or Position	:	BUSINESS DIRECTOR
Name	:	MIRIAM GOEBEL
Credential	:
Telephone Number	:	702-526-7482

Provider Enumeration Date	:	06/22/2022
Last Update Date	:	01/02/2025

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