Provider Demographics
NPI:1689258063
Name:ST TERRYS HOSPITIUM & PALLIATIVE CARE LLC
Entity Type:Organization
Organization Name:ST TERRYS HOSPITIUM & PALLIATIVE CARE LLC
Other - Org Name:ST TERRY'S HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:MARIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KUCHAKHCHIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-542-8455
Mailing Address - Street 1:3824 S JONES BLVD STE F1
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-2453
Mailing Address - Country:US
Mailing Address - Phone:702-542-8455
Mailing Address - Fax:
Practice Address - Street 1:3824 S JONES BLVD STE F1
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-2453
Practice Address - Country:US
Practice Address - Phone:702-542-8455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-11
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based