Provider Demographics
NPI:1811294671
Name:JILL RACHELE ENTERPRISES, INC.
Entity type:Organization
Organization Name:JILL RACHELE ENTERPRISES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:RACHELE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:540-903-2555
Mailing Address - Street 1:1235 EAST BLVD
Mailing Address - Street 2:SUITE K
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5870
Mailing Address - Country:US
Mailing Address - Phone:704-335-4070
Mailing Address - Fax:
Practice Address - Street 1:1235 EAST BLVD
Practice Address - Street 2:SUITE K
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5870
Practice Address - Country:US
Practice Address - Phone:704-335-4070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-14
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
6485470001Medicare NSC