NPIMap

Organization Active NPI

Puricare Health Services LLC

  • Community Based Hospice Care Agency
  • Las Vegas, NV
National Provider Identifier
1295490357
Registry record updated Nov 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
PURICARE HEALTH SERVICES LLC
Practice address
2320 Paseo del Prado Ste B106-C
Las Vegas, NV 89102-4358
Phone
(702) 575-9558
NPI assigned
Nov 3, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2021

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

Authorized official

Name
Ashley Delaine Flores
Title
Manager
Phone
(702) 575-9558

Specialties & licenses 1

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

Addresses

Primary practice location

2320 Paseo del Prado Ste B106-C
Las Vegas, NV 89102-4358

Mailing address

2320 Paseo del Prado Ste B106-C
Las Vegas, NV 89102-4358
Phone (702) 575-9558

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220518000640 NV Part A Provider - Hospice 0345627089 Practice locations: Las Vegas, NV

Hospice certification: CCN 291628

Legal name
PURICARE HEALTH SERVICES LLC
Certification status
Active
Provider type (POS)
Hospice
Participating since
Oct 11, 2022
Last certification
Sep 14, 2022
Ownership / control type
Proprietary - Corporation
Organization structure
LLCProprietary
Enrollment address
3885 S Decatur Blvd
Ste 1055
Las Vegas, NV 89103-5872

Care Compare: Hospice

Medicare Care Compare
Listed as
Puricare Health Services LLCCCN 291628
Certified
Oct 11, 2022
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Locations

3885 S Decatur Blvd
Ste 1055
Las Vegas, NV 89103
Phone (702) 248-4345

2320 Paseo del Prado
Ste B106C
Las Vegas, NV 89102
Phone (702) 575-9558

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Elaine Manliclic-Dela Cuesta Individual 5% Or Greater Direct Ownership Interest Dec 26, 2023 50%
Corporate OfficerCeo/President Dec 26, 2023 50%
W-2 Managing EmployeeCeo/President Dec 26, 2023 50%
Operational/Managerial ControlCeo/President Dec 26, 2023
Amit Valera Individual Corporate DirectorMedical Director Dec 26, 2023
Mercy C Labrado Individual 5% Or Greater Direct Ownership InterestVice President Dec 26, 2023 50%
Corporate Officer Dec 26, 2023 50%
W-2 Managing EmployeeAdministrator Dec 26, 2023 50%
Operational/Managerial ControlVice President Dec 26, 2023 50%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Affiliated clinicians 3

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": "1635897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635897600000",
    "number": "1295490357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2320 PASEO DEL PRADO STE B106-C",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891024358",
            "telephone_number": "702-575-9558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2320 PASEO DEL PRADO STE B106-C",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891024358",
            "telephone_number": "702-575-9558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PURICARE HEALTH SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-03",
        "last_updated": "2021-11-03",
        "certification_date": "2021-11-03",
        "status": "A",
        "authorized_official_last_name": "FLORES",
        "authorized_official_first_name": "ASHLEY DELAINE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "702-575-9558"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.