MEDICARE: CORDIAL CARE HOSPICE 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	:	1720761448
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORDIAL CARE HOSPICE INC

Provider Business Mailing Address
First Line	:	5280 S EASTERN AVE STE G8
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-2303
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5280 S EASTERN AVE STE G8
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-2303
Country	:	US
Telephone Number	:	702-551-2555
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	TIGRAN BAKALYAN
Credential	:
Telephone Number	:	702-551-2555

Provider Enumeration Date	:	08/09/2023
Last Update Date	:	08/09/2023

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