Provider Demographics
NPI:1376391771
Name:REIGNITE AND REFORM LLC
Entity type:Organization
Organization Name:REIGNITE AND REFORM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:TRINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:516-710-3498
Mailing Address - Street 1:121 GRANBY PARK
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-4101
Mailing Address - Country:US
Mailing Address - Phone:516-710-3498
Mailing Address - Fax:
Practice Address - Street 1:121 GRANBY PARK
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-4101
Practice Address - Country:US
Practice Address - Phone:516-710-3498
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health