MEDICARE: SACRED HEART 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	:	1609501097
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SACRED HEART LLC

Provider Business Mailing Address
First Line	:	3311 S RAINBOW BLVD STE 101
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-6596
Country	:	US
Telephone Number	:	725-247-0388
Fax Number	:

Provider Business Practice Location Address
First Line	:	3311 S RAINBOW BLVD STE 101
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-6596
Country	:	US
Telephone Number	:	725-247-0388
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. FRANCISCO RETIRADO
Credential	:
Telephone Number	:	702-321-6145

Provider Enumeration Date	:	07/19/2022
Last Update Date	:	08/23/2022

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Directions to “SACRED HEART LLC ” Practice Location

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