Organization
REACH BEYOND, LCC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. RHONDA JO GRAY B.S. (OWNER)
(208) 200-9106
Entity
Organization
Contact information
Practice address
1395 CAMBRIDGE DR, IDAHO FALLS, ID 83401-4208
(208) 200-9106
Mailing address
PO BOX 1384, IDAHO FALLS, ID 83403-1384
(208) 200-9106
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101810019
MEDICAID APPLICATION NUMBER
ID
Enumeration date
08/25/2010
Last updated
10/02/2012
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