Provider Demographics
NPI:1992027411
Name:REENTRY CORPORATION OF AMERICA
Entity Type:Organization
Organization Name:REENTRY CORPORATION OF AMERICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:DUVOR
Authorized Official - Last Name:STEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-247-2499
Mailing Address - Street 1:12379 LEGACY HILLS DR
Mailing Address - Street 2:
Mailing Address - City:GEISMAR
Mailing Address - State:LA
Mailing Address - Zip Code:70734-3164
Mailing Address - Country:US
Mailing Address - Phone:504-595-5015
Mailing Address - Fax:504-595-5626
Practice Address - Street 1:260 PEACHTREE ST NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-1202
Practice Address - Country:US
Practice Address - Phone:225-247-2499
Practice Address - Fax:504-595-5626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder