Basic Information
| Provider Information | |||||||||
| NPI: | 1891093621 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GRACEFUL TOUCH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 N RAINBOW BLVD STE 28 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891071189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022933888 | ||||||||
| FaxNumber: | 7022933664 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 N RAINBOW BLVD STE 28 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891071189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022933888 | ||||||||
| FaxNumber: | 7022933664 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2011 | ||||||||
| LastUpdateDate: | 11/22/2021 | ||||||||
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| AuthorizedOfficialLastName: | MITCHELL | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER/ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7022933888 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | NV20101141308 | NV | N | Agencies | Home Health | 302F00000X | NV20101141308 | NV | N | Managed Care Organizations | Exclusive Provider Organization | 253Z00000X | Y | Agencies | In Home Supportive Care |
ID Information
| ID | Type | State | Issuer | Description | 1891093621 | 05 | NV | MEDICAID |