Provider Demographics
NPI:1083121453
Name:CHRISTIAN HOSPICE, LLC
Entity Type:Organization
Organization Name:CHRISTIAN HOSPICE, LLC
Other - Org Name:CHRISTIAN HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BASILIO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:702-331-3911
Mailing Address - Street 1:5523 S EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-2312
Mailing Address - Country:US
Mailing Address - Phone:702-331-3911
Mailing Address - Fax:702-331-6229
Practice Address - Street 1:5523 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-2312
Practice Address - Country:US
Practice Address - Phone:702-331-3911
Practice Address - Fax:702-331-6229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-06
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2080H0002X, 251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251G00000XAgenciesHospice Care, Community BasedGroup - Multi-Specialty
No2080H0002XAllopathic & Osteopathic PhysiciansPediatricsHospice and Palliative MedicineGroup - Multi-Specialty