Healthcare Provider Details

I. General information

NPI: 1649600131
Provider Name (Legal Business Name): MR. CRAIG AL HANCOCK II
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2013
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3016 W CHARLESTON BLVD STE 150
LAS VEGAS NV
89102-1964
US

IV. Provider business mailing address

4217 EL CONLON AVE APT 2017
LAS VEGAS NV
89102-0623
US

V. Phone/Fax

Practice location:
  • Phone: 702-371-7970
  • Fax:
Mailing address:
  • Phone: 702-371-7970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberCHW-5915
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: