Basic Information
| Provider Information | |||||||||
| NPI: | 1750328589 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LAS VEGAS SOLARI HOSPICE CARE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 E WARM SPRINGS RD | ||||||||
| Address2: | #300 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891194305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022163346 | ||||||||
| FaxNumber: | 7026716883 | ||||||||
| Practice Location | |||||||||
| Address1: | 5550 S JONES BLVD | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891180566 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028700000 | ||||||||
| FaxNumber: | 7028709500 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2006 | ||||||||
| LastUpdateDate: | 05/31/2016 | ||||||||
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| AuthorizedOfficialLastName: | KOGOOD | ||||||||
| AuthorizedOfficialFirstName: | DENNIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7029328555 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | NV | Y | Agencies | Hospice Care, Community Based |
ID Information
| ID | Type | State | Issuer | Description | 1750328589 | 05 | NV | MEDICAID |