Provider Demographics
NPI:1811128507
Name:REACHING OUT AND BEYOND LLC
Entity type:Organization
Organization Name:REACHING OUT AND BEYOND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:BOATMAN-HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-484-0095
Mailing Address - Street 1:302 BRADFORD AVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-5406
Mailing Address - Country:US
Mailing Address - Phone:910-484-0095
Mailing Address - Fax:187-799-6337
Practice Address - Street 1:302 BRADFORD AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-5406
Practice Address - Country:US
Practice Address - Phone:910-484-0095
Practice Address - Fax:187-799-6337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-026-875251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health