MEDICARE: LVNV HOSPICE

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	:	1982032710
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LVNV HOSPICE

Provider Business Mailing Address
First Line	:	3301 SPRING MOUNTAIN RD
Second Line	:	SUITE 10
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-8648
Country	:	US
Telephone Number	:	702-380-8202
Fax Number	:

Provider Business Practice Location Address
First Line	:	596 N LAKE AVE
Second Line	:	203
City	:	PASADENA
State	:	CA
Zip	:	91101-1222
Country	:	US
Telephone Number	:	626-272-5943
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GINA CASTROMAYOR
Credential	:	RN
Telephone Number	:	714-408-6522

Provider Enumeration Date	:	10/14/2013
Last Update Date	:	10/14/2013

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