NPIMap

Organization Active NPI

Liberty Creek Hospice, LLC

  • Community Based Hospice Care Agency
  • Las Vegas, NV
National Provider Identifier
1700232402
Registry record updated May 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
NV20161219404 Issued in NV
Legal business name
LIBERTY CREEK HOSPICE, LLC
Practice address
2310 Paseo del Prado Ste A203
Las Vegas, NV 89102-4330
Phone
(702) 910-2333
NPI assigned
May 11, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2016

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

Authorized official

Name
Ms. Nympha GarciaNPI 1447606835
Title
Ceo
Phone
(702) 910-2333

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X NV20161219404 NV Primary

Addresses

Primary practice location

2310 Paseo del Prado Ste A203
Las Vegas, NV 89102-4330

Mailing address

2310 Paseo del Prado Ste A203
Las Vegas, NV 89102-4330
Phone (702) 910-2333

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170508001864 NV Part A Provider - Hospice 6406133040 Practice locations: Las Vegas, NV

Hospice certification: CCN 291558

Legal name
LIBERTY CREEK HOSPICE LLC
Certification status
Active
Provider type (POS)
Hospice
Participating since
May 19, 2018
Last certification
Mar 18, 2021
Ownership / control type
Proprietary - Partnership
Organization structure
LLCProprietary
Incorporated
in NV
Enrollment address
2310 Paseo del Prado
Ste A201
Las Vegas, NV 89102-4330

Care Compare: Hospice

Medicare Care Compare
Listed as
Liberty Creek Hospice, LLCCCN 291558 · All quality measures
Ownership
For-Profit
Certified
May 19, 2018
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Locations

2310 Paseo del Prado
Ste A203
Las Vegas, NV 89102
Phone (702) 910-2333

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Nympha Garcia Individual 5% Or Greater Direct Ownership Interest Apr 13, 2016 33.33%
Corporate DirectorCeo Apr 13, 2016 33.33%
W-2 Managing EmployeeCeo Apr 13, 2016
John Cabatu Individual 5% Or Greater Direct Ownership InterestAdministrator Apr 13, 2016 33.33%
Corporate OfficerBoard Member Cfo Treasurer Apr 13, 2016 33.33%
Corporate DirectorBoard Member Apr 13, 2016
W-2 Managing EmployeeCfo Treasurer Administrator DPCS Apr 13, 2016 33.33%
Don Leo Pepito Individual Corporate DirectorMedical Director Apr 13, 2016
Celestine Cabatu Individual 5% Or Greater Direct Ownership Interest Apr 13, 2016 33.33%
Corporate OfficerBoard Member Coo Secretary Apr 13, 2016 33.33%
Corporate Director Apr 13, 2016
W-2 Managing EmployeeCoo Secretary Apr 13, 2016 33.33%

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

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

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": "1462924800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1462924800000",
    "number": "1700232402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2310 PASEO DEL PRADO STE A203",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891024330",
            "telephone_number": "702-910-2333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2310 PASEO DEL PRADO STE A203",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891024330",
            "telephone_number": "702-910-2333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY CREEK HOSPICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-11",
        "last_updated": "2016-05-11",
        "status": "A",
        "authorized_official_last_name": "GARCIA",
        "authorized_official_first_name": "NYMPHA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "702-910-2333",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NV",
            "license": "NV20161219404",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.