Provider Demographics
NPI:1609508183
Name:REFLECTIONS COMMUNITY SERVICE PROGRAM LLC
Entity Type:Organization
Organization Name:REFLECTIONS COMMUNITY SERVICE PROGRAM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DEVANTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANKS
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:773-851-7381
Mailing Address - Street 1:3310 MID VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-9495
Mailing Address - Country:US
Mailing Address - Phone:920-469-9646
Mailing Address - Fax:
Practice Address - Street 1:323 N MORRISON ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-5404
Practice Address - Country:US
Practice Address - Phone:920-840-6247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MACHT VILLAGE PROGRAMS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health