Healthcare Provider Details

I. General information

NPI: 1215051388
Provider Name (Legal Business Name): REACH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 07/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 3RD ST
JUNEAU AK
99801-1220
US

IV. Provider business mailing address

213 3RD ST
JUNEAU AK
99801-1220
US

V. Phone/Fax

Practice location:
  • Phone: 907-586-8228
  • Fax: 907-586-8226
Mailing address:
  • Phone: 907-586-8228
  • Fax: 907-586-8226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberHC7127
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License NumberHC7127
License Number StateAK

VIII. Authorized Official

Name: RICHARD FAGUNDES
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 907-586-8228