Provider Demographics
NPI:1902330574
Name:GENESIS HOSPICE, LLC
Entity Type:Organization
Organization Name:GENESIS HOSPICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:QUERUBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:IGUBAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-753-7626
Mailing Address - Street 1:2620 RUBY VISTA DR
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-1638
Mailing Address - Country:US
Mailing Address - Phone:775-753-7626
Mailing Address - Fax:
Practice Address - Street 1:2620 RUBY VISTA DR
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-1638
Practice Address - Country:US
Practice Address - Phone:775-753-7626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based