| Raphael Recovery And Support Llc | |
|
7848 23rd Ln Se Lacey WA 98503-3300 | |
| (406) 461-0960 | |
| Not Available |
| Full Name | Raphael Recovery And Support Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 7848 23rd Ln Se, Lacey, Washington |
| Authorized Official Name and Position | Maria Valdenegro (OWNER) |
| Authorized Official Contact | 4064610960 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Raphael Recovery And Support Llc 7848 23rd Ln Se Lacey WA 98503-3300 Ph: (406) 461-0960 | Raphael Recovery And Support Llc 7848 23rd Ln Se Lacey WA 98503-3300 Ph: (406) 461-0960 |
| NPI Number | 1578375879 |
|---|---|
| Provider Enumeration Date | 01/23/2025 |
| Last Update Date | 01/23/2025 |
| Certification Date | 01/23/2025 |
| Medicare PECOS PAC ID | 3173043429 |
|---|---|
| Medicare Enrollment ID | O20250218000791 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578375879 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Neil Sarmiento Lacanlale |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255926853 PECOS PAC ID: 0042695272 Enrollment ID: I20220923001298 |
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