Provider Demographics
NPI:1003277427
Name:REACH FOR SENIORS LLC
Entity Type:Organization
Organization Name:REACH FOR SENIORS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:CROCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-653-4616
Mailing Address - Street 1:30092 BERLIN DORY RD
Mailing Address - Street 2:
Mailing Address - City:SEDLEY
Mailing Address - State:VA
Mailing Address - Zip Code:23878-2205
Mailing Address - Country:US
Mailing Address - Phone:757-653-4616
Mailing Address - Fax:
Practice Address - Street 1:30092 BERLIN DORY RD
Practice Address - Street 2:
Practice Address - City:SEDLEY
Practice Address - State:VA
Practice Address - Zip Code:23878-2205
Practice Address - Country:US
Practice Address - Phone:757-653-4616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-12
Last Update Date:2016-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAS3703776253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care