Healthcare Provider Details

I. General information

NPI: 1992435762
Provider Name (Legal Business Name): REACHING AROUND FOR YOU II, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2022
Last Update Date: 06/14/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13349 HIGHWAY 742 N
POLKTON NC
28135-7727
US

IV. Provider business mailing address

3300 CAPPADOCIA CHURCH RD
POLKTON NC
28135-9259
US

V. Phone/Fax

Practice location:
  • Phone: 704-690-0152
  • Fax:
Mailing address:
  • Phone: 704-690-0152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: INEZ WILLIAMSON
Title or Position: PROGRAM MANAGER
Credential:
Phone: 704-690-0152