Healthcare Provider Details

I. General information

NPI: 1760725535
Provider Name (Legal Business Name): REACHING POTENTIAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2013
Last Update Date: 04/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

934 JACK ALLEN RD
DIXON KY
42409-9738
US

IV. Provider business mailing address

934 JACK ALLEN RD
DIXON KY
42409-9738
US

V. Phone/Fax

Practice location:
  • Phone: 270-869-4296
  • Fax: 859-712-0414
Mailing address:
  • Phone: 270-869-4296
  • Fax: 859-712-0414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: JOHN EDWARD HUDSON
Title or Position: MANAGING MEMBER
Credential:
Phone: 270-869-4296