Provider Demographics
NPI:1043652811
Name:RECONNECT SERVICES LLC
Entity Type:Organization
Organization Name:RECONNECT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:OLUFUNKE
Authorized Official - Middle Name:OYERONKE
Authorized Official - Last Name:ADETUNJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-291-8313
Mailing Address - Street 1:9825 GOOD LUCK RD APT 7
Mailing Address - Street 2:
Mailing Address - City:SEABROOK
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3364
Mailing Address - Country:US
Mailing Address - Phone:240-291-8313
Mailing Address - Fax:
Practice Address - Street 1:9825 GOOD LUCK RD APT 7
Practice Address - Street 2:
Practice Address - City:SEABROOK
Practice Address - State:MD
Practice Address - Zip Code:20706-3364
Practice Address - Country:US
Practice Address - Phone:240-291-8313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-22
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4175305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service