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General NPI Number Information
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NPI Number | 1184443095
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Entity Type | Organization
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Legal Business Name | REACH REDEEM RESTORE WELLNESS LLC
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Dates
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Enumeration Date | 10/08/2024
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 708 PULASKI HWY STE B-1
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City | JOPPA
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State | MD
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Zip | 21085-3926
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Country | US
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Telephone | 443-402-5052
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Fax |
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Provider Business Mailing Address
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Address Line | 708 PULASKI HWY STE B-1
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City | JOPPA
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State | MD
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Zip | 21085-3926
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Country | US
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Telephone | 443-402-5052
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE
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Name | INYANG AMINA EDOHO
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Credential |
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Telephone | 240-920-9103
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 276400000X
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Taxonomy Name | Substance Use Disorder Rehabilitation Hospital Unit
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3104A0630X
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Taxonomy Name | Assisted Living Facility (Behavioral Disturbances)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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