Provider Demographics
NPI:1326555483
Name:GRACEFUL TOUCH, LLC
Entity Type:Organization
Organization Name:GRACEFUL TOUCH, LLC
Other - Org Name:GRACEFUL TOUCH, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-293-3888
Mailing Address - Street 1:800 N RAINBOW BLVD
Mailing Address - Street 2:212
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-1189
Mailing Address - Country:US
Mailing Address - Phone:702-293-3888
Mailing Address - Fax:702-293-3664
Practice Address - Street 1:800 N RAINBOW BLVD
Practice Address - Street 2:212
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-1189
Practice Address - Country:US
Practice Address - Phone:702-293-3888
Practice Address - Fax:702-293-3664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-10
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6048PCS-6251E00000X, 302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1538546635Medicaid
NV1891093621Medicaid