Healthcare Provider Details

I. General information

NPI: 1508274846
Provider Name (Legal Business Name): RACC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2014
Last Update Date: 07/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 W PASADENA AVE
PHOENIX AZ
85013-2086
US

IV. Provider business mailing address

37 W PASADENA AVE
PHOENIX AZ
85013-2086
US

V. Phone/Fax

Practice location:
  • Phone: 602-400-6488
  • Fax: 855-288-9241
Mailing address:
  • Phone: 602-400-6488
  • Fax: 855-288-9241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2050X
TaxonomyRespite Care Camp
License Number
License Number State

VIII. Authorized Official

Name: RUSLAN RAZINN
Title or Position: GENERAL MANAGER
Credential:
Phone: 602-803-9575