Provider Demographics
NPI:1134801194
Name:REBUILDING & EVOLVING FAMILIES LLC
Entity type:Organization
Organization Name:REBUILDING & EVOLVING FAMILIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER /OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:DETRA
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS TODD
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:317-728-4239
Mailing Address - Street 1:9770 JACKSON WAY
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-9588
Mailing Address - Country:US
Mailing Address - Phone:317-728-4239
Mailing Address - Fax:
Practice Address - Street 1:9770 JACKSON WAY
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-9588
Practice Address - Country:US
Practice Address - Phone:317-728-4239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-01
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child