Healthcare Provider Details

I. General information

NPI: 1497215883
Provider Name (Legal Business Name): R.E.A.C.H. PROJECT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 03/21/2019
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 Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: GREG MOORE
Title or Position: PROGRAM MANAGER
Credential:
Phone: 925-754-3673