MEDICARE: CANDY HAIR 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	332B00000X	Durable Medical Equipment & Medical Supplies
2	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1740050160
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CANDY HAIR LLC

Provider Business Mailing Address
First Line	:	7181 N HUALAPAI WAY STE 130-933
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89166-1115
Country	:	US
Telephone Number	:	702-904-2640
Fax Number	:	702-446-6290

Provider Business Practice Location Address
First Line	:	9220 ALBUS HILLS AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89143-1232
Country	:	US
Telephone Number	:	702-904-2640
Fax Number	:	702-446-6290

Authorized Official
Title or Position	:	OWNER OPERATOR
Name	:	NIKKI A RACHAL
Credential	:	MS
Telephone Number	:	702-904-2640

Provider Enumeration Date	:	01/05/2024
Last Update Date	:	05/07/2026

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Directions to “CANDY HAIR LLC ” Practice Location

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