Healthcare Provider Details

I. General information

NPI: 1578201653
Provider Name (Legal Business Name): REACHING MILESTONE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2022
Last Update Date: 10/10/2022
Certification Date: 10/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 SARA LN
RICHMOND VA
23224-2761
US

IV. Provider business mailing address

2325 SARA LN
RICHMOND VA
23224-2761
US

V. Phone/Fax

Practice location:
  • Phone: 804-955-7134
  • Fax: 804-728-3597
Mailing address:
  • Phone: 804-955-7134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. MONIQUE ALTERISS CLARK
Title or Position: CEO
Credential: BSW
Phone: 180-495-5713