Healthcare Provider Details

I. General information

NPI: 1699544825
Provider Name (Legal Business Name): RAE 6 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2023
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10209 W RIVERSIDE AVE
TOLLESON AZ
85353-8304
US

IV. Provider business mailing address

10209 W RIVERSIDE AVE
TOLLESON AZ
85353-8304
US

V. Phone/Fax

Practice location:
  • Phone: 480-616-1409
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN CELESKI
Title or Position: EDUCATION
Credential:
Phone: 480-616-1409