Provider Demographics
NPI:1164779906
Name:ANCILE PALLIATIVE CARE, INC
Entity Type:Organization
Organization Name:ANCILE PALLIATIVE CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST. ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-985-1944
Mailing Address - Street 1:9315 W SUNSET RD
Mailing Address - Street 2:SUITE 101-C
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5011
Mailing Address - Country:US
Mailing Address - Phone:702-985-1944
Mailing Address - Fax:702-405-0161
Practice Address - Street 1:9315 W SUNSET RD
Practice Address - Street 2:SUITE 101-C
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5011
Practice Address - Country:US
Practice Address - Phone:702-985-1944
Practice Address - Fax:702-405-0161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-10
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20121349662251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVNV20121349662OtherNEVADA BUSINESS IDENTIFICATION