MEDICARE: JILL RACHELE ENTERPRISES, INC.

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1811294671
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JILL RACHELE ENTERPRISES, INC.

Provider Business Mailing Address
First Line	:	1235 EAST BLVD
Second Line	:	SUITE K
City	:	CHARLOTTE
State	:	NC
Zip	:	28203-5870
Country	:	US
Telephone Number	:	704-335-4070
Fax Number	:

Provider Business Practice Location Address
First Line	:	1235 EAST BLVD
Second Line	:	SUITE K
City	:	CHARLOTTE
State	:	NC
Zip	:	28203-5870
Country	:	US
Telephone Number	:	704-335-4070
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	MISS JILL RACHELE SMITH
Credential	:	CPED
Telephone Number	:	540-903-2555

Provider Enumeration Date	:	02/14/2011
Last Update Date	:	03/07/2011

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