MEDICARE: RAYFORD ENTERPRISES LLC

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	385H00000X	Respite Care
2	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1700455318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAYFORD ENTERPRISES LLC

Provider Business Mailing Address
First Line	:	3508 TERRAZA MAR AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-6600
Country	:	US
Telephone Number	:	702-824-6580
Fax Number	:

Provider Business Practice Location Address
First Line	:	3508 TERRAZA MAR AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-6600
Country	:	US
Telephone Number	:	702-824-6580
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	KELLARICE R RAYFORD
Credential	:
Telephone Number	:	702-800-9839

Provider Enumeration Date	:	06/18/2021
Last Update Date	:	06/18/2021

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Directions to “RAYFORD ENTERPRISES LLC ” Practice Location

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