Provider Demographics
NPI:1235697293
Name:REACH LLC
Entity Type:Organization
Organization Name:REACH LLC
Other - Org Name:REACH BEHAVORIAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:FORNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-815-1171
Mailing Address - Street 1:1 N CHARLES ST STE 222
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-3710
Mailing Address - Country:US
Mailing Address - Phone:410-449-1199
Mailing Address - Fax:443-769-1567
Practice Address - Street 1:1 N CHARLES ST STE 222
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-3710
Practice Address - Country:US
Practice Address - Phone:410-449-1199
Practice Address - Fax:443-769-1567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-08
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1235697293Medicaid