Provider Demographics
NPI:1447832969
Name:BE REFORMED
Entity type:Organization
Organization Name:BE REFORMED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RHAQUESE
Authorized Official - Middle Name:ASHANTI
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:850-242-1689
Mailing Address - Street 1:5661 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:FL
Mailing Address - Zip Code:32344-5425
Mailing Address - Country:US
Mailing Address - Phone:850-242-1689
Mailing Address - Fax:
Practice Address - Street 1:5661 LAKE RD
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:FL
Practice Address - Zip Code:32344-5425
Practice Address - Country:US
Practice Address - Phone:850-242-1689
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health