MEDICARE: MAKAHLA GRAY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	253Z00000X	In Home Supportive Care Agency
2	372500000X	Chore Provider	NE
3	376J00000X	Homemaker	NE
4	253Z00000X	In Home Supportive Care Agency	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942920327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAKAHLA GRAY

Provider Business Mailing Address
First Line	:	942 N 28TH AVE
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68131-1504
Country	:	US
Telephone Number	:	402-510-6066
Fax Number	:

Provider Business Practice Location Address
First Line	:	942 N 28TH AVE
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68131-1504
Country	:	US
Telephone Number	:	402-510-6066
Fax Number	:

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

Provider Enumeration Date	:	08/29/2022
Last Update Date	:	08/29/2022

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Directions to “ MAKAHLA GRAY ” Practice Location

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