MEDICARE: EMERALD CARE 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

General Provider Information

NPI Number	:	1871276238
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMERALD CARE HOSPICE LLC

Provider Business Mailing Address
First Line	:	3885 S DECATUR BLVD STE 2000A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-5873
Country	:	US
Telephone Number	:	702-613-8842
Fax Number	:

Provider Business Practice Location Address
First Line	:	3885 S DECATUR BLVD STE 2000A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-5873
Country	:	US
Telephone Number	:	702-613-8842
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MIKI TON
Credential	:
Telephone Number	:	702-755-1800

Provider Enumeration Date	:	08/10/2023
Last Update Date	:	08/10/2023

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