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NPI Code Detail

MEDICARE: RAYCHEL SLACK

MEDICARE: RAYCHEL SLACK
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
13747P1801XPersonal Care Attendant

General Provider Information

NPI Number : 1235781477
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAYCHEL SLACK
Provider Business Mailing Address
First Line : 3052 BALCONES FAULT AVE
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89081-6409
Country : US
Telephone Number : 702-236-6158
Fax Number :
Provider Business Practice Location Address
First Line : 3052 BALCONES FAULT AVE
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89081-6409
Country : US
Telephone Number : 702-236-6158
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/09/2019
Last Update Date : 07/09/2019

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Directions to “ RAYCHEL SLACK ” Practice Location

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