Sun City Hospice Inc
Organization Active NPI Community Based Hospice Care Agency · Las Vegas, NV
NPI 1104517036 · NPPES record last updated May 19, 2023
Key facts
- NPI
- 1104517036
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Based Hospice Care Agency 251G00000X
- Legal business name
- SUN CITY HOSPICE INC
- Practice address
- 2780 S Jones Blvd Ste 108
Las Vegas, NV 89146-5641 - Phone
- (702) 333-4433
- Fax
- (702) 333-4352
- NPI assigned
- May 19, 2023
- Organization subpart
- No
Authorized official
- Name
- Georgiy Gelashvili
- Title
- Ceo
- Phone
- (702) 333-4433
Owners & managing parties with NPI records 1
-
Daniel Itano, D.O.
Practitioners 5
-
Sung J Cho, PSY.D.
-
Sara Elizabeth Marchon, LCSW
-
Thomas Eugene Williams, MSW LICSW
-
Mark Philo Short, PSY.D.
Affiliated clinicians 3
-
Bashir Qadir Rashid, M.D.
-
Daniel Itano, D.O.
Medicare Care Compare: Hospice
- Listed as
- Sun City Hospice Inc
- Certified
- Aug 16, 2023
- Medicare certification status
- Active
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 29D2323780 | Sun City Hospice Inc | Certificate of waiver | May 12, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NV
Hospice certification: CCN 291663
- Legal name
- SUN CITY HOSPICE INC
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Aug 16, 2023
- Last certification
- Aug 11, 2023
- Organization structure
- Corporation · Proprietary
- Incorporated
- Dec 14, 2021 in CA
- Enrollment address
- 2780 S Jones Blvd
Ste 108
Las Vegas, NV 89146-5641
All disclosed owners & managing parties 3
| Name | Role | Since | Share |
|---|---|---|---|
| Jaklina Gelashvili |
W-2 Managing Employee |
May 1, 2026 | |
| Daniel Itano |
W-2 Managing Employee |
May 1, 2026 | |
| Georgiy Gelashvili |
5% Or Greater Direct Ownership Interest |
Dec 14, 2021 | 100% |
| Corporate Officer |
Dec 14, 2021 | 100% | |
| Corporate Director |
Dec 14, 2021 | 100% | |
| W-2 Managing Employee |
Dec 14, 2021 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230614000757 | NV | Part a Provider - Hospice | 9436517059 | Practice locations: Las Vegas, NV |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | Yes |
Addresses
Primary practice location
2780 S Jones Blvd Ste 108
Las Vegas, NV 89146-5641
Mailing address
2780 S Jones Blvd Ste 108
Las Vegas, NV 89146-5641
Phone (702) 333-4433
Other providers in Las Vegas, NV
- Summit Wellness of DPSW LLC
- Summit Wound Healing LLC
- Shalysha Summit
- Deandre Lamont Summlin
- Sun City Foot Care
- Sun City Medical Center PLLC
- Sun City Medical Transport
- Sun Dental Professional Corporation
- Sun Medical & Mobility Equipment
- Sun RX Drugs Inc
All providers in Las Vegas, 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 May 19, 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.