MEDICARE: ELSIE GONZALES KAECKER

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	372500000X	Chore Provider	NV
2	372600000X	Adult Companion	NV
3	3747A0650X	Attendant Care Provider	NV
4	376J00000X	Homemaker	NV
5	3747P1801X	Personal Care Attendant	NV

General Provider Information

NPI Number	:	1508366097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELSIE GONZALES KAECKER

Provider Business Mailing Address
First Line	:	4050 PALOS VERDES ST APT 14
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6956
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2001 S JONES BLVD STE F
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-3165
Country	:	US
Telephone Number	:	702-202-3452
Fax Number	:	702-982-8727

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

Provider Enumeration Date	:	02/20/2018
Last Update Date	:	02/20/2018

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