MEDICARE: LUCKEY RAIN WELLNESS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174H00000X	Health Educator
2	171400000X	Health & Wellness Coach

General Provider Information

NPI Number	:	1265260491
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUCKEY RAIN WELLNESS LLC

Provider Business Mailing Address
First Line	:	11357 NUCKOLS RD # 2012
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059-5504
Country	:	US
Telephone Number	:	804-575-1033
Fax Number	:

Provider Business Practice Location Address
First Line	:	8401 MAYLAND DR STE A
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23294-4648
Country	:	US
Telephone Number	:	833-548-3348
Fax Number	:

Authorized Official
Title or Position	:	TRAINING DIRECTOR
Name	:	MR. RAYMOND D LUCKEY JR.
Credential	:
Telephone Number	:	804-575-1033

Provider Enumeration Date	:	07/22/2024
Last Update Date	:	08/21/2024

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