MEDICARE: REESE HEALTH SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility		NC

General Provider Information

NPI Number	:	1699196766
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REESE HEALTH SERVICES

Provider Business Mailing Address
First Line	:	1900 MCALLISTER DR APT C
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-0050
Country	:	US
Telephone Number	:	704-392-3174
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 MCALLISTER DR APT C
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-0050
Country	:	US
Telephone Number	:	704-392-3174
Fax Number	:

Authorized Official
Title or Position	:	CERTIFIED NURSE
Name	:	MR. LAWRENCE REESE
Credential	:	CNA
Telephone Number	:	980-428-2473

Provider Enumeration Date	:	12/17/2013
Last Update Date	:	12/17/2013

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