MEDICARE: REACHING YOUR GOALS, INC..

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	MHL-092-721	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902044795
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REACHING YOUR GOALS, INC..

Provider Business Mailing Address
First Line	:	211 E SIX FORKS RD
Second Line	:	STE 201
City	:	RALEIGH
State	:	NC
Zip	:	27609-7745
Country	:	US
Telephone Number	:	919-832-6150
Fax Number	:	919-832-6151

Provider Business Practice Location Address
First Line	:	1201 KENT RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27606-1977
Country	:	US
Telephone Number	:	919-832-6150
Fax Number	:	919-832-6151

Authorized Official
Title or Position	:	PRESIDNET
Name	:	MRS. REBA R WILLIAMS
Credential	:	MS
Telephone Number	:	919-832-6150

Provider Enumeration Date	:	02/02/2009
Last Update Date	:	02/02/2009

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