Provider Demographics
NPI:1720725542
Name:REACHING DEVELOPMENTAL MILESTONES LLC
Entity Type:Organization
Organization Name:REACHING DEVELOPMENTAL MILESTONES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:EBONE
Authorized Official - Middle Name:TENISHA
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-694-8987
Mailing Address - Street 1:3011 TOWN CENTER DR. SUITE 130 UNIT #142
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306
Mailing Address - Country:US
Mailing Address - Phone:800-736-0548
Mailing Address - Fax:
Practice Address - Street 1:9451 COATS RD
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NC
Practice Address - Zip Code:28356-9563
Practice Address - Country:US
Practice Address - Phone:910-694-8987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-13
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency