MEDICARE: EDICO HEALTH SERVICES CORP

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	85414	NV

General Provider Information

NPI Number	:	1811168495
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDICO HEALTH SERVICES CORP

Provider Business Mailing Address
First Line	:	3365 W CRAIG RD
Second Line	:	STE. 2 & 19
City	:	N LAS VEGAS
State	:	NV
Zip	:	89032-5112
Country	:	US
Telephone Number	:	702-697-2005
Fax Number	:	702-697-2006

Provider Business Practice Location Address
First Line	:	3365 W CRAIG RD
Second Line	:	STE. 2 & 19
City	:	N LAS VEGAS
State	:	NV
Zip	:	89032-5112
Country	:	US
Telephone Number	:	702-697-2005
Fax Number	:	702-697-2006

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	EDITH CARINO AVANZADO
Credential	:	RD, NHA
Telephone Number	:	702-466-5738

Provider Enumeration Date	:	03/21/2008
Last Update Date	:	03/21/2008

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