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NPI Code Detail

MEDICARE: JENAI GACCIONE MSW

MEDICARE: JENAI GACCIONE MSW
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
1171M00000XCase Manager/Care Coordinator
2225400000XRehabilitation Practitioner

General Provider Information

NPI Number : 1235553090
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENAI GACCIONE MSW
Provider Business Mailing Address
First Line : 1640 E FLAMINGO RD
Second Line : #100
City : LAS VEGAS
State : NV
Zip : 89119-5249
Country : US
Telephone Number : 702-369-4357
Fax Number :
Provider Business Practice Location Address
First Line : 1640 E FLAMINGO RD
Second Line : #100
City : LAS VEGAS
State : NV
Zip : 89119-5249
Country : US
Telephone Number : 702-369-4357
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2014
Last Update Date : 05/28/2014

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