Provider Demographics
NPI:1043451867
Name:REACH OUT SUPPORT SERVICES
Entity type:Organization
Organization Name:REACH OUT SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-347-1359
Mailing Address - Street 1:185 FOXCROFT LN
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-8621
Mailing Address - Country:US
Mailing Address - Phone:252-347-1359
Mailing Address - Fax:
Practice Address - Street 1:185 FOXCROFT LN
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590-8621
Practice Address - Country:US
Practice Address - Phone:252-347-1359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No252Y00000XAgenciesEarly Intervention Provider Agency