Healthcare Provider Details

I. General information

NPI: 1467606780
Provider Name (Legal Business Name): REACHING FOR HIGHER GOALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2008
Last Update Date: 11/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 KENT DR
FOREST CITY NC
28043-2891
US

IV. Provider business mailing address

PO BOX 283
GROVER NC
28073-0283
US

V. Phone/Fax

Practice location:
  • Phone: 828-245-6191
  • Fax:
Mailing address:
  • Phone: 704-477-2635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberMHL-080048
License Number StateNC

VIII. Authorized Official

Name: MRS. DONNA GIDNEY
Title or Position: OWNER
Credential:
Phone: 704-477-2635