Provider Demographics
NPI:1649398835
Name:ANGEL EYE HOSPICE, LLC
Entity Type:Organization
Organization Name:ANGEL EYE HOSPICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELANCY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:702-737-1771
Mailing Address - Street 1:2770 S MARYLAND PKWY
Mailing Address - Street 2:SUITE 413
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-1554
Mailing Address - Country:US
Mailing Address - Phone:702-737-1771
Mailing Address - Fax:702-737-7871
Practice Address - Street 1:2770 S MARYLAND PKWY
Practice Address - Street 2:SUITE 512
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-1554
Practice Address - Country:US
Practice Address - Phone:702-737-1771
Practice Address - Fax:702-737-7871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4119HPC1251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV291522Medicare Oscar/Certification