MEDICARE: REACHING YOUR GOALS INC

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	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility	MHL-092-603	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881795169
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REACHING YOUR GOALS INC

Provider Business Mailing Address
First Line	:	1220 NOWELL RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27607-5134
Country	:	US
Telephone Number	:	919-500-3464
Fax Number	:	919-800-3971

Provider Business Practice Location Address
First Line	:	7625 MINE VALLEY RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27615-6017
Country	:	US
Telephone Number	:	919-500-3464
Fax Number	:	919-800-3971

Authorized Official
Title or Position	:	DIRECTOR/PRESIDENT
Name	:	MS. REBA M ROYSTER
Credential	:	BS QMHP
Telephone Number	:	919-880-5451

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	12/16/2013

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