Healthcare Provider Details

I. General information

NPI: 1891093621
Provider Name (Legal Business Name): GRACEFUL TOUCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2011
Last Update Date: 11/22/2021
Certification Date: 11/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N RAINBOW BLVD STE 28
LAS VEGAS NV
89107-1189
US

IV. Provider business mailing address

800 N RAINBOW BLVD STE 28
LAS VEGAS NV
89107-1189
US

V. Phone/Fax

Practice location:
  • Phone: 702-293-3888
  • Fax: 702-293-3664
Mailing address:
  • Phone: 702-293-3888
  • Fax: 702-293-3664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberNV20101141308
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License NumberNV20101141308
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: CHARLES MITCHELL
Title or Position: MANAGER/ADMINISTRATOR
Credential:
Phone: 702-293-3888