MEDICARE: REGINALD MAURICE RALPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	261QA0600X	Adult Day Care Clinic/Center
3	385H00000X	Respite Care
4	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1679334775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REGINALD MAURICE RALPH

Provider Business Mailing Address
First Line	:	417 CLARA DR
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23320-7031
Country	:	US
Telephone Number	:	757-277-6070
Fax Number	:	757-277-6070

Provider Business Practice Location Address
First Line	:	1932 KEMPSVILLE RD STE 107
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-6953
Country	:	US
Telephone Number	:	757-277-6070
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2024
Last Update Date	:	03/29/2024

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