Provider Demographics
NPI:1649404930
Name:REYNOLDS CARE SUPPORT, LLC
Entity Type:Organization
Organization Name:REYNOLDS CARE SUPPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:PURCELL
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:336-324-7931
Mailing Address - Street 1:PO BOX 4629
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27289-4629
Mailing Address - Country:US
Mailing Address - Phone:336-324-7931
Mailing Address - Fax:
Practice Address - Street 1:207 N MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:WALNUT COVE
Practice Address - State:NC
Practice Address - Zip Code:27052-9201
Practice Address - Country:US
Practice Address - Phone:336-324-7931
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management