Canyon Nevada LLC
Organization Active NPI Community Based Hospice Care Agency · Laughlin, NV
NPI 1922520675 · NPPES record last updated May 9, 2025
Key facts
- NPI
- 1922520675
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Based Hospice Care Agency 251G00000X
- Legal business name
- CANYON NEVADA LLC
- Practice address
- 3100 S Needles Hwy Ste 500
Laughlin, NV 89029-0815 - Phone
- (702) 868-1400
- Fax
- (702) 720-1423
- NPI assigned
- Jul 14, 2017
- Organization subpart
- No
Authorized official
- Name
- Breezie Liskey
- Title
- VP of Operations
- Phone
- (801) 456-7874
Owners & managing parties with NPI records 2
Other NPIs with the same Medicare PAC ID 1
Corporate family (same tax ID) 1
Member of 1
Facilities with the same owner 9
Practitioners 57
-
Tammy Ahler, RN
-
Alexandria Breitkopf, CNA
-
Shari Brewer, CNA
-
Kayla Brock, RN
-
Stevie Brown, RN
-
Sherri L Church, RN
-
Rodney S Clousing, OTA
-
Bonnie Corley, RN
-
Samantha Edwards, RN
-
Jackelin Estrada, LPN
-
Jacqueline Flores, CNA
-
Jennifer Gerali, RN
-
Charles Jordan, OTA
-
Brenda Lee, RN
-
Brandy Masavage, RN
-
Alexis Mattson, CNA
-
Nicole McQuillan, RN
-
Airanna Melchor, LPN
-
Kaylee Menk, PTA
-
Teena M Mitchelle, PCA
-
Raylin Moya, CNA
-
Maddie Naugle, RN
-
Aimee Pickens, RN
-
Rebecca Prosise, RN
Affiliated clinicians 1
-
Murray M Rosenberg, M.D.
Medicare Care Compare: Hospice
- Listed as
- Canyon Home Care & Hospice
- Ownership
- For-Profit
- Certified
- Mar 8, 2018
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NV
Hospice certification: CCN 291557
- Legal name
- CANYON NEVADA LLC
- Doing business as
- CANYON HOME CARE & HOSPICE
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Mar 8, 2018
- Last certification
- Jan 15, 2021
- Ownership / control type
- Proprietary - Corporation
- Organization structure
- LLC · Proprietary
- Incorporated
- May 31, 2017 in NV
- Enrollment address
- 3100 S Needles Hwy
Ste 600
Laughlin, NV 89029-0815
All disclosed owners & managing parties 5
| Name | Role | Since | Share |
|---|---|---|---|
| Orange Healthcare, LLC |
5% Or Greater Indirect Ownership Interest | May 31, 2017 | 50% |
| Kenneth Edwin Norris |
5% Or Greater Indirect Ownership Interest | May 31, 2017 | 50% |
| Corporate Officer |
May 31, 2017 | 100% | |
| Operational/Managerial Control |
May 31, 2017 | 100% | |
| Tyson Cichos |
5% Or Greater Indirect Ownership Interest | May 31, 2017 | 25% |
| Cory R Robison |
5% Or Greater Indirect Ownership Interest | May 31, 2017 | 25% |
| Home Caregivers Partnership, LLC |
5% Or Greater Direct Ownership Interest | May 31, 2017 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170830000892 | NV | Part a Provider - Hospice | 0648543462 | Practice locations: Laughlin, NV |
National Provider Directory
- Tax ID family
- Canyon Home Care
Locations
786 W Pioneer Blvd
Ste 105
Mesquite, NV 89027
Phone (702) 897-9566
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | Yes |
Addresses
Primary practice location
3100 S Needles Hwy Ste 500
Laughlin, NV 89029-0815
Mailing address
746 E Winchester St Ste 200
Salt Lake City, UT 84107-8513
Phone (801) 485-6166
Other practice location 1
786 W Pioneer Blvd Ste 105
Mesquite, NV 89027-8888
Phone (702) 897-9566
Other names
- Canyon Home Care & Hospice
Other providers in Laughlin, NV
- Stevie Brown
- Bullhead City Clinic Corp
- Leanna Burk
- Heidi Callahan
- Canyon Nevada LLC
- Jiann Choo
- Sherri L Church
- Rodney S Clousing
- Community Birth Group
- Bonnie Corley
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 May 9, 2025. 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.