MEDICARE: ADVISACARE SOLUTIONS OF NEVADA, INC.

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	:	1558871822
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVISACARE SOLUTIONS OF NEVADA, INC.

Provider Business Mailing Address
First Line	:	4234 CASCADE RD SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-8384
Country	:	US
Telephone Number	:	616-464-1117
Fax Number	:	616-464-1044

Provider Business Practice Location Address
First Line	:	1840 E WARM SPRINGS RD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-4585
Country	:	US
Telephone Number	:	702-837-0699
Fax Number	:	702-896-6401

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KRISTIAN E SKOGEN
Credential	:
Telephone Number	:	702-837-0699

Provider Enumeration Date	:	10/02/2017
Last Update Date	:	10/02/2017

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