Healthcare Provider Details

I. General information

NPI: 1891407086
Provider Name (Legal Business Name): REACH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2214 JEFFERSON ST
BALTIMORE MD
21205-2407
US

IV. Provider business mailing address

1 N CHARLES ST STE 222
BALTIMORE MD
21201-3710
US

V. Phone/Fax

Practice location:
  • Phone: 443-529-9083
  • Fax:
Mailing address:
  • Phone: 443-831-1171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. IVAN FORNEY
Title or Position: CO-OWNER
Credential:
Phone: 443-815-1171