Provider Demographics
NPI:1033519111
Name:PEBBLE CREEK OF LAS VEGAS, LLC
Entity Type:Organization
Organization Name:PEBBLE CREEK OF LAS VEGAS, LLC
Other - Org Name:PEBBLE CREEK HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:J
Authorized Official - Middle Name:
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-948-0510
Mailing Address - Street 1:2810 S RAINBOW BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-5150
Mailing Address - Country:US
Mailing Address - Phone:702-818-4500
Mailing Address - Fax:702-444-7758
Practice Address - Street 1:2810 S RAINBOW BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5150
Practice Address - Country:US
Practice Address - Phone:702-818-4500
Practice Address - Fax:702-444-7758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-26
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based