Provider Demographics
NPI:1609040237
Name:INFINITY HOSPICE CARE OF LAS VEGAS LLC
Entity Type:Organization
Organization Name:INFINITY HOSPICE CARE OF LAS VEGAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:BERTRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-381-0375
Mailing Address - Street 1:5110 N 40TH ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2126
Mailing Address - Country:US
Mailing Address - Phone:602-381-0375
Mailing Address - Fax:
Practice Address - Street 1:6330 SOUTH JONES BOULEVARD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-3302
Practice Address - Country:US
Practice Address - Phone:702-880-7002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4890HPC-1251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV291521Medicare Oscar/Certification