MEDICARE: LIFE CARE AT HOME OF NEVADA, 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	4635HPC-0	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902847338
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE CARE AT HOME OF NEVADA, INC

Provider Business Mailing Address
First Line	:	3001 KEITH ST NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312-3713
Country	:	US
Telephone Number	:	423-473-5268
Fax Number	:	423-339-8356

Provider Business Practice Location Address
First Line	:	2700 E SUNSET RD
Second Line	:	SUITE 36D
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3506
Country	:	US
Telephone Number	:	702-380-1006
Fax Number	:	702-380-1142

Authorized Official
Title or Position	:	VICE PRESIDENT FINANCE
Name	:	PAMELA RAU
Credential	:
Telephone Number	:	423-473-5280

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	01/30/2013

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