MEDICARE: LIBERTY CREEK 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	NV20161219404	NV

General Provider Information

NPI Number	:	1700232402
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIBERTY CREEK HOSPICE, LLC

Provider Business Mailing Address
First Line	:	2310 PASEO DEL PRADO STE A203
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-4330
Country	:	US
Telephone Number	:	702-910-2333
Fax Number	:

Provider Business Practice Location Address
First Line	:	2310 PASEO DEL PRADO STE A203
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-4330
Country	:	US
Telephone Number	:	702-910-2333
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. NYMPHA GARCIA
Credential	:
Telephone Number	:	702-910-2333

Provider Enumeration Date	:	05/11/2016
Last Update Date	:	05/11/2016

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