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General NPI Number Information
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NPI Number | 1710653407
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Entity Type | Individual
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Provider Name | RAECHELLE ANGELEE MOFFETT CEO, LVN
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Gender | Female
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Dates
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Enumeration Date | 08/21/2021
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Last Update Date | 06/07/2023
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Provider Practice Location Address
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Address Line | 5702 GREENGATE DR APT D
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City | KILLEEN
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State | TX
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Zip | 76543-9006
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Country | US
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Telephone | 254-245-8058
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Fax | 254-699-4189
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Provider Business Mailing Address
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Address Line | 5702 GREENGATE DR APT D
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City | KILLEEN
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State | TX
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Zip | 76543-9006
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Country | US
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Telephone | 254-681-7975
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Fax | 254-699-4189
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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Taxonomy #3
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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Taxonomy #4
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Taxonomy Code | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | 327311
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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Taxonomy #6
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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Taxonomy #7
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Taxonomy Code | 332U00000X
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Taxonomy Name | Home Delivered Meals
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Taxonomy #8
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Taxonomy Code | 372500000X
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Taxonomy Name | Chore Provider
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Taxonomy #9
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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Taxonomy #10
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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Taxonomy #11
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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Taxonomy #12
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number |
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Taxonomy #13
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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