Provider Demographics
NPI:1447827795
Name:WAFFORD, RAECHEL
Entity type:Individual
Prefix:
First Name:RAECHEL
Middle Name:
Last Name:WAFFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11119 WHITEHILL ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48224-2467
Mailing Address - Country:US
Mailing Address - Phone:586-436-9777
Mailing Address - Fax:
Practice Address - Street 1:11119 WHITEHILL ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48224-2467
Practice Address - Country:US
Practice Address - Phone:586-436-9777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIW163730081620Medicaid