Healthcare Provider Details

I. General information

NPI: 1992027411
Provider Name (Legal Business Name): REENTRY CORPORATION OF AMERICA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2010
Last Update Date: 02/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 PEACHTREE ST NW
ATLANTA GA
30303-1202
US

IV. Provider business mailing address

12379 LEGACY HILLS DR
GEISMAR LA
70734-3164
US

V. Phone/Fax

Practice location:
  • Phone: 225-247-2499
  • Fax: 504-595-5626
Mailing address:
  • Phone: 504-595-5015
  • Fax: 504-595-5626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. REGINALD DUVOR STEWMAN
Title or Position: PRESIDENT
Credential:
Phone: 225-247-2499