MEDICARE: QUALITY OF LIFE 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

General Provider Information

NPI Number	:	1528752391
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUALITY OF LIFE HOSPICE, LLC

Provider Business Mailing Address
First Line	:	6375 S PECOS RD STE 220
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3271
Country	:	US
Telephone Number	:	702-595-0058
Fax Number	:

Provider Business Practice Location Address
First Line	:	6375 S PECOS RD STE 220
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3271
Country	:	US
Telephone Number	:	702-595-0058
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NANA GYEABOUR
Credential	:
Telephone Number	:	702-595-0058

Provider Enumeration Date	:	06/05/2023
Last Update Date	:	06/05/2023

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