Healthcare Provider Details

I. General information

NPI: 1043451867
Provider Name (Legal Business Name): REACH OUT SUPPORT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2009
Last Update Date: 03/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 FOXCROFT LN
WINTERVILLE NC
28590-8621
US

IV. Provider business mailing address

185 FOXCROFT LN
WINTERVILLE NC
28590-8621
US

V. Phone/Fax

Practice location:
  • Phone: 252-347-1359
  • Fax:
Mailing address:
  • Phone: 252-347-1359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. JOHNNY LEE FLEMING
Title or Position: CEO / OWNER
Credential:
Phone: 252-347-1359