MEDICARE: PROCARE HOSPICE 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		NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	291534	OTHER		MEDICARE PTAN

General Provider Information

NPI Number	:	1700137395
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROCARE HOSPICE OF NEVADA, LLC

Provider Business Mailing Address
First Line	:	9811 W CHARLESTON BLVD
Second Line	:	SUITE 2628
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-7528
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8025 AMIGO ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-1210
Country	:	US
Telephone Number	:	702-380-8300
Fax Number	:	702-380-8302

Authorized Official
Title or Position	:	CFO
Name	:	GREGORY WALSKI
Credential	:
Telephone Number	:	702-380-8300

Provider Enumeration Date	:	09/24/2012
Last Update Date	:	09/02/2021

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