Provider Demographics
NPI:1043659378
Name:REYNA HOME CARE
Entity type:Organization
Organization Name:REYNA HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR / COO
Authorized Official - Prefix:MR
Authorized Official - First Name:REYNALDO
Authorized Official - Middle Name:MENDOZA
Authorized Official - Last Name:DELA CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MECHANICAL ENGINEER
Authorized Official - Phone:757-650-5312
Mailing Address - Street 1:5321 HICKORY RDG
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-6681
Mailing Address - Country:US
Mailing Address - Phone:757-650-5312
Mailing Address - Fax:757-961-5869
Practice Address - Street 1:945 EDWIN DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-3066
Practice Address - Country:US
Practice Address - Phone:757-962-4770
Practice Address - Fax:757-961-5869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1958251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services