- Enrollment id
- O20231016001248
- Enrollment state
- NV
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1699469247
- Multiple npi flag
- N
- Ccn
- 291682
- Associate id
- 0042665770
- Organization name
- REVERENT HOSPICE CARE INC
- Incorporation date
- 2023-06-05
- Incorporation state
- NV
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 11500 S EASTERN AVE
- Address line 2
- STE 150
- City
- HENDERSON
- State
- NV
- Zip code
- 890525576