Hospice of Laughlin LLC
Organization Active NPI Community Based Hospice Care Agency · Laughlin, NV
NPI 1043885908 · NPPES record last updated Apr 20, 2023
Key facts
- NPI
- 1043885908
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Based Hospice Care Agency 251G00000X
- Legal business name
- HOSPICE OF LAUGHLIN LLC
- Practice address
- 3030 S Needles Hwy Ste 1400
Laughlin, NV 89029-0893 - Phone
- (314) 815-3500
- NPI assigned
- May 24, 2021
- Organization subpart
- No
Authorized official
- Name
- Tracey Sulzberger, RN
- Title
- Compliance Director
- Phone
- (314) 815-3500
Owners & managing parties with NPI records 2
-
Khurram Jehangir Khan, M.D.
-
William John Moriconi, M.D.
Facilities with the same owner 5
Affiliated clinicians 1
-
Siamak N Nabili, M.D.
Medicare Care Compare: Hospice
- Listed as
- Beacon of Hope Hospice
- Certified
- Sep 6, 2022
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NV
Hospice certification: CCN 291623
- Legal name
- HOSPICE OF LAUGHLIN LLC
- Doing business as
- BEACON OF HOPE HOSPICE
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Sep 6, 2022
- Last certification
- Aug 24, 2022
- Ownership / control type
- Proprietary - Individual
- Organization structure
- LLC · Proprietary
- Incorporated
- Apr 13, 2021 in NV
- Enrollment address
- 3030 S Needles Hwy
Ste 1400
Laughlin, NV 89029-0893
All disclosed owners & managing parties 6
| Name | Role | Since | Share |
|---|---|---|---|
| Jamie Lynn Smith |
Operational/Managerial Control |
Dec 22, 2021 | |
| Tracey Sulzberger |
Corporate Director |
Apr 13, 2021 | |
| Kandy M Mecum |
Corporate Officer |
Apr 13, 2021 | |
| National Hospice Management, Inc |
5% Or Greater Direct Ownership Interest | Apr 21, 2021 | 100% |
| William John Moriconi |
Corporate Officer |
Apr 13, 2021 | |
| Khurram J Khan |
Corporate Director |
Jan 1, 2026 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220406002240 | NV | Part a Provider - Hospice | 2264828904 | Practice locations: Laughlin, NV |
National Provider Directory
Locations
3030 S Needles Hwy
Ste 1400
Laughlin, NV 89029
Phone (314) 815-3500
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | Yes |
Addresses
Primary practice location
3030 S Needles Hwy Ste 1400
Laughlin, NV 89029-0893
Mailing address
2191 Lemay Ferry Rd Ste 300
Saint Louis, MO 63125-2483
Phone (314) 815-3500
Other names
- Beacon of Hope Hospice
Other providers in Laughlin, NV
- Jennifer Gerali
- Gina Gillespie
- Carol Girton
- Demare Hall
- Hivellc
- Suzanne Marie Howard
- Alison Hurst
- Img Laughlin PLLC
- Jaldeep H Daulat DO Professional Corporation
- James Michael Johns
All providers in Laughlin, NV · Community Based Hospice Care Agency in Nevada
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 20, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.