Provider Demographics
NPI:1679343925
Name:REYNA CARE LLC
Entity Type:Organization
Organization Name:REYNA CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ALTERNATE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-274-3660
Mailing Address - Street 1:3143 S 840 E STE 310
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-8547
Mailing Address - Country:US
Mailing Address - Phone:435-274-3660
Mailing Address - Fax:
Practice Address - Street 1:3143 S 840 E STE 310
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-8547
Practice Address - Country:US
Practice Address - Phone:435-274-3660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care