Provider Demographics
NPI:1710174487
Name:REACH OF JACKSON COUNTY
Entity Type:Organization
Organization Name:REACH OF JACKSON COUNTY
Other - Org Name:REACH OF JACKSON CO. INC
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOCKSTAHLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-631-4488
Mailing Address - Street 1:PO BOX 1908
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-1908
Mailing Address - Country:US
Mailing Address - Phone:828-631-4488
Mailing Address - Fax:828-631-4477
Practice Address - Street 1:22 BROWNING RD
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-3202
Practice Address - Country:US
Practice Address - Phone:828-631-4488
Practice Address - Fax:828-631-4477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2462/4691/4506101Y00000X, 101YM0800X
NC2462/ CERT.#42101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005520Medicaid