Provider Demographics
NPI:1811168495
Name:EDICO HEALTH SERVICES CORP
Entity type:Organization
Organization Name:EDICO HEALTH SERVICES CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:CARINO
Authorized Official - Last Name:AVANZADO
Authorized Official - Suffix:
Authorized Official - Credentials:RD, NHA
Authorized Official - Phone:702-466-5738
Mailing Address - Street 1:3365 W CRAIG RD
Mailing Address - Street 2:STE. 2 & 19
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-5112
Mailing Address - Country:US
Mailing Address - Phone:702-697-2005
Mailing Address - Fax:702-697-2006
Practice Address - Street 1:3365 W CRAIG RD
Practice Address - Street 2:STE. 2 & 19
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-5112
Practice Address - Country:US
Practice Address - Phone:702-697-2005
Practice Address - Fax:702-697-2006
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EDICO HEALTH SERVICES CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-21
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV85414251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based