Provider Demographics
NPI:1841296795
Name:PHYSICIANS CHOICE HOSPICE LLC
Entity type:Organization
Organization Name:PHYSICIANS CHOICE HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:WREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-563-1717
Mailing Address - Street 1:6720 VIA AUSTI PARKWAY
Mailing Address - Street 2:SUITE NUMBER 250
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-3568
Mailing Address - Country:US
Mailing Address - Phone:702-563-1717
Mailing Address - Fax:702-563-1718
Practice Address - Street 1:6720 VIA AUSTI PARKWAY
Practice Address - Street 2:SUITE #250
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-2568
Practice Address - Country:US
Practice Address - Phone:702-563-1717
Practice Address - Fax:702-563-1718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-24
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV679HPC-13251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ764391Medicaid
NV006502020Medicaid
NV006402020Medicaid
AZ291508Medicare ID - Type UnspecifiedAZ MEDICARE