=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275767691
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REGIONAL EMPLOYEE ASSISTANCE PROGRAM INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/13/2009
-----------------------------------------------------
Last Update Date | 05/13/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 600 N PARK ST
-----------------------------------------------------
City | BRENHAM
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77833-2610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 979-830-0530
-----------------------------------------------------
Fax | 979-830-0559
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2403 N LAURENT ST
-----------------------------------------------------
City | VICTORIA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77901-4119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-579-0315
-----------------------------------------------------
Fax | 361-579-0325
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF PROVIDER ENROLLMENT
-----------------------------------------------------
Name | DEBBIE T BREWER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 877-892-9813
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------