Provider Demographics
NPI:1417674995
Name:CELESTIAL HOSPICE LLC
Entity Type:Organization
Organization Name:CELESTIAL HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDICHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:725-218-9741
Mailing Address - Street 1:4200 W CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1625
Mailing Address - Country:US
Mailing Address - Phone:702-268-8197
Mailing Address - Fax:
Practice Address - Street 1:4200 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1625
Practice Address - Country:US
Practice Address - Phone:702-268-8197
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based