Provider Demographics
NPI:1609235050
Name:CENTENNIAL GROUP LLC
Entity Type:Organization
Organization Name:CENTENNIAL GROUP LLC
Other - Org Name:CENTENNIAL HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:CANLAS
Authorized Official - Last Name:ANTOLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-590-4690
Mailing Address - Street 1:8589 SILVER COAST ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-6799
Mailing Address - Country:US
Mailing Address - Phone:323-423-9950
Mailing Address - Fax:702-965-2987
Practice Address - Street 1:4535 W SAHARA AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-3625
Practice Address - Country:US
Practice Address - Phone:702-527-5553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-13
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8419HPC-0251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based