Provider Demographics
NPI:1700232402
Name:LIBERTY CREEK HOSPICE, LLC
Entity Type:Organization
Organization Name:LIBERTY CREEK HOSPICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:NYMPHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-910-2333
Mailing Address - Street 1:2310 PASEO DEL PRADO STE A203
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-4330
Mailing Address - Country:US
Mailing Address - Phone:702-910-2333
Mailing Address - Fax:
Practice Address - Street 1:2310 PASEO DEL PRADO STE A203
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-4330
Practice Address - Country:US
Practice Address - Phone:702-910-2333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20161219404251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based