Healthcare Provider Details

I. General information

NPI: 1922815877
Provider Name (Legal Business Name): HOMING REACH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2024
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 GOLDEN OAK CT STE 150
VIRGINIA BEACH VA
23452-8512
US

IV. Provider business mailing address

207 WYNN ST
PORTSMOUTH VA
23701-3141
US

V. Phone/Fax

Practice location:
  • Phone: 757-749-2125
  • Fax:
Mailing address:
  • Phone: 757-749-2125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MONTY MARSHALL
Title or Position: PRESIDENT
Credential:
Phone: 757-749-2125