Provider Demographics
NPI:1417163494
Name:REACH PROJECT, INC.
Entity Type:Organization
Organization Name:REACH PROJECT, INC.
Other - Org Name:CENTRAL FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-754-3673
Mailing Address - Street 1:1915 D ST
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-2571
Mailing Address - Country:US
Mailing Address - Phone:925-754-3673
Mailing Address - Fax:
Practice Address - Street 1:1915 D ST
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-2571
Practice Address - Country:US
Practice Address - Phone:925-754-3673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA070024AN251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0753OtherDRUG MEDICAL BILLING NO
CA070753OtherMASTER PROVIDER NUMBER
CA07534OtherDMC ADULT ANTIOCH
CA07536OtherDMC ADOL ANTIOCH