MEDICARE: RCLALC,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	310400000X	Assisted Living Facility	10760	SD

General Provider Information

NPI Number	:	1760835052
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RCLALC,LLC

Provider Business Mailing Address
First Line	:	17912 GOTHARD ST
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-6218
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	409 E FAIRLANE DR
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-7207
Country	:	US
Telephone Number	:	605-399-1551
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	BRIAN ROBERT UHLIR
Credential	:
Telephone Number	:	530-242-8300

Provider Enumeration Date	:	07/21/2016
Last Update Date	:	07/21/2016

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