1245503838 NPI number — THRESHOLDS HOSPICE OF NEVADA LLC

Table of content: (NPI 1245503838)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245503838 NPI number — THRESHOLDS HOSPICE OF NEVADA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THRESHOLDS HOSPICE OF NEVADA LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245503838
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12040 RAYMOND CT
Provider Second Line Business Mailing Address:
ST 1
Provider Business Mailing Address City Name:
HUNTLEY
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60142-8069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-637-2200
Provider Business Mailing Address Fax Number:
847-515-1503

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 S RANCHO DR
Provider Second Line Business Practice Location Address:
STE A-6
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89106-4899
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-767-2469
Provider Business Practice Location Address Fax Number:
702-631-7778
Provider Enumeration Date:
02/14/2012

Additional Information

Authorized Official

Authorized Official Last Name:
PALAZZO
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
M
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
815-637-2200

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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