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General NPI Number Information
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NPI Number | 1952118036
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Entity Type | Organization
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Legal Business Name | RICHMOND EQUITY AND EMPOWERMENT INITIATIVE, INC.
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Dates
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Enumeration Date | 12/12/2024
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Last Update Date | 04/04/2025
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Provider Practice Location Address
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Address Line | 770 SONOMA ST
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City | RICHMOND
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State | CA
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Zip | 94805-1500
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Country | US
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Telephone | 510-447-4070
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Fax |
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Provider Business Mailing Address
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Address Line | 770 SONOMA ST
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City | RICHMOND
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State | CA
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Zip | 94805-1500
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Country | US
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Telephone | 510-447-4070
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. BILLY RAY WYDERMYER JR.
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Credential |
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Telephone | 707-333-9336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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Taxonomy #3
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Taxonomy Code | 251X00000X
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Taxonomy Name | Supports Brokerage Agency
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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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