Provider Demographics
NPI:1750821187
Name:REICHARD FAMILY SERVICES OF VIRGINIA, INC.
Entity Type:Organization
Organization Name:REICHARD FAMILY SERVICES OF VIRGINIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:REICHARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-546-0457
Mailing Address - Street 1:PO BOX 11903
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24506-1903
Mailing Address - Country:US
Mailing Address - Phone:434-546-0457
Mailing Address - Fax:
Practice Address - Street 1:104 MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-3223
Practice Address - Country:US
Practice Address - Phone:434-546-0457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-04
Last Update Date:2017-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0214786102Medicaid