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General NPI Number Information
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NPI Number | 1679334775
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Entity Type | Individual
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Provider Name | REGINALD MAURICE RALPH
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Gender | Male
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Dates
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Enumeration Date | 01/17/2024
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Last Update Date | 03/29/2024
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Provider Practice Location Address
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Address Line | 1932 KEMPSVILLE RD STE 107
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-6953
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Country | US
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Telephone | 757-277-6070
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Fax |
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Provider Business Mailing Address
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Address Line | 417 CLARA DR
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City | CHESAPEAKE
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State | VA
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Zip | 23320-7031
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Country | US
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Telephone | 757-277-6070
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Fax | 757-277-6070
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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Taxonomy #3
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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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 | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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