Organization Active NPI

Amity Hospice Care LLC

  • Community Based Hospice Care Agency
  • Las Vegas, NV
National Provider Identifier
1003566027
Registry record updated Nov 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
AMITY HOSPICE CARE LLC
Practice address
1515 E Tropicana Ave Ste 300
Las Vegas, NV 89119-6519
Phone
(702) 777-1285
NPI assigned
Mar 24, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Vyjay E Balangue, BUSINESS DEVELOPMENT
Title
Business Development
Phone
(702) 954-9798

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X Primary

Addresses

Primary practice location

1515 E Tropicana Ave Ste 300
Las Vegas, NV 89119-6519

Mailing address

1515 E Tropicana Ave Ste 300
Las Vegas, NV 89119-6519
Phone (702) 777-1285

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL Office Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220523000094 NV Part A Provider - Hospice 2567849003 Practice locations: Las Vegas, NV

Hospice certification: CCN 291651

Legal name
AMITY HOSPICE CARE LLC
Certification status
Active
Provider type (POS)
Hospice
Participating since
Aug 17, 2023
Last certification
Aug 2, 2023
Organization structure
LLCProprietary
Enrollment address
1515 E Tropicana Ave
Ste 300
Las Vegas, NV 89119-6519

Care Compare: Hospice

Medicare Care Compare
Listed as
Amity Hospice Care LLCCCN 291651
Certified
Aug 17, 2023
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Locations

1515 E Tropicana Ave
Ste 300
Las Vegas, NV 89119
Phone (702) 777-1285

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Vyjay Balangue Individual 5% Or Greater Direct Ownership Interest Aug 15, 2019 40%
Corporate OfficerCfo Aug 15, 2019 40%
Corporate DirectorCfo Aug 15, 2019 40%
Jayson Berena Individual 5% Or Greater Direct Ownership Interest Aug 15, 2019 60%
Corporate OfficerCeo Aug 15, 2019 60%
Corporate DirectorCeo Aug 15, 2019 60%
W-2 Managing EmployeeCeo Aug 15, 2019 60%

Practitioners & affiliated clinicians

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1648080000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699488000000",
    "number": "1003566027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 E TROPICANA AVE STE 300",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891196519",
            "telephone_number": "702-777-1285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 E TROPICANA AVE STE 300",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891196519",
            "telephone_number": "702-777-1285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMITY HOSPICE CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-24",
        "last_updated": "2023-11-09",
        "certification_date": "2023-11-09",
        "status": "A",
        "authorized_official_last_name": "BALANGUE",
        "authorized_official_first_name": "VYJAY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "BUSINESS DEVELOPMENT",
        "authorized_official_telephone_number": "702-954-9798",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "BUSINESS DEVELOPMENT"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Office",
            "affiliation": "N",
            "endpointDescription": "Office",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1515 E Tropicana Ave Ste 300",
            "city": "Las Vegas",
            "state": "NV",
            "country_code": "US",
            "postal_code": "891196519",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.