Provider Demographics
NPI:1821304064
Name:REACH BEYOND, LCC
Entity Type:Organization
Organization Name:REACH BEYOND, LCC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:208-200-9106
Mailing Address - Street 1:PO BOX 1384
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83403-1384
Mailing Address - Country:US
Mailing Address - Phone:208-200-9106
Mailing Address - Fax:
Practice Address - Street 1:1395 CAMBRIDGE DR
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-4208
Practice Address - Country:US
Practice Address - Phone:208-200-9106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-25
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID101810019OtherMEDICAID APPLICATION NUMBER