Provider Demographics
NPI:1760725535
Name:REACHING POTENTIAL, LLC
Entity Type:Organization
Organization Name:REACHING POTENTIAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-869-4296
Mailing Address - Street 1:934 JACK ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:KY
Mailing Address - Zip Code:42409-9738
Mailing Address - Country:US
Mailing Address - Phone:270-869-4296
Mailing Address - Fax:859-712-0414
Practice Address - Street 1:934 JACK ALLEN RD
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:KY
Practice Address - Zip Code:42409-9738
Practice Address - Country:US
Practice Address - Phone:270-869-4296
Practice Address - Fax:859-712-0414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-31
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management