MEDICARE: RACC 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	385HR2050X	Respite Care Camp
2	302R00000X	Health Maintenance Organization

General Provider Information

NPI Number	:	1508274846
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RACC LLC

Provider Business Mailing Address
First Line	:	37 W PASADENA AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85013-2086
Country	:	US
Telephone Number	:	602-400-6488
Fax Number	:	855-288-9241

Provider Business Practice Location Address
First Line	:	37 W PASADENA AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85013-2086
Country	:	US
Telephone Number	:	602-400-6488
Fax Number	:	855-288-9241

Authorized Official
Title or Position	:	GENERAL MANAGER
Name	:	RUSLAN RAZINN
Credential	:
Telephone Number	:	602-803-9575

Provider Enumeration Date	:	07/31/2014
Last Update Date	:	07/31/2014

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Directions to “RACC LLC ” Practice Location

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