Provider Demographics
NPI:1679817738
Name:REVERSING FALLS LLC
Entity Type:Organization
Organization Name:REVERSING FALLS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:TALIAFERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-794-3492
Mailing Address - Street 1:1 FAIRCHILD PL
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:NY
Mailing Address - Zip Code:12701-2005
Mailing Address - Country:US
Mailing Address - Phone:845-794-3492
Mailing Address - Fax:845-794-3494
Practice Address - Street 1:1 FAIRCHILD PL
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-2005
Practice Address - Country:US
Practice Address - Phone:845-794-3492
Practice Address - Fax:845-794-3494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty