MEDICARE: CHARLI MACKABEE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1144518440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLI MACKABEE

Provider Business Mailing Address
First Line	:	15095 AMARGOSA RD STE 208
Second Line	:
City	:	VICTORVILLE
State	:	CA
Zip	:	92394-1879
Country	:	US
Telephone Number	:	760-245-4695
Fax Number	:

Provider Business Practice Location Address
First Line	:	3170 E SUNSET RD
Second Line	:	A
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-2745
Country	:	US
Telephone Number	:	702-629-6000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2011
Last Update Date	:	01/10/2018

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Directions to “ CHARLI MACKABEE ” Practice Location

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