Provider Demographics
NPI:1962996793
Name:GRACE HOSPICE OF NEVADA LLC
Entity type:Organization
Organization Name:GRACE HOSPICE OF NEVADA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OTHER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEMETRIO
Authorized Official - Middle Name:
Authorized Official - Last Name:ENCABO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:702-201-1807
Mailing Address - Street 1:2330 PASEO DEL PRADO STE C201
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-4376
Mailing Address - Country:US
Mailing Address - Phone:702-201-1807
Mailing Address - Fax:725-307-8717
Practice Address - Street 1:2330 PASEO DEL PRADO STE C201
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-4376
Practice Address - Country:US
Practice Address - Phone:702-201-1807
Practice Address - Fax:725-307-8717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-15
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20181348397251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVNV20181348397OtherNEVADA STATE BUSINESS LICENSE