Healthcare Provider Details

I. General information

NPI: 1417163494
Provider Name (Legal Business Name): REACH PROJECT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 02/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 D ST
ANTIOCH CA
94509-2571
US

IV. Provider business mailing address

1915 D ST
ANTIOCH CA
94509-2571
US

V. Phone/Fax

Practice location:
  • Phone: 925-754-3673
  • Fax:
Mailing address:
  • Phone: 925-754-3673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number070024AN
License Number StateCA

VIII. Authorized Official

Name: MS. MARY A. WILLIAMS
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 925-754-3673