Provider Demographics
NPI:1508609280
Name:MOJAVE HOSPICE LLC
Entity type:Organization
Organization Name:MOJAVE HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDICHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:725-218-9741
Mailing Address - Street 1:2320 PASEO DEL PRADO STE B106
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-4331
Mailing Address - Country:US
Mailing Address - Phone:725-218-9741
Mailing Address - Fax:
Practice Address - Street 1:2320 PASEO DEL PRADO STE B106
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-4331
Practice Address - Country:US
Practice Address - Phone:725-218-9741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-18
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based