1598070013 NPI number — REARDON RESIDENTIAL SERVICES, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598070013 NPI number — REARDON RESIDENTIAL SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REARDON RESIDENTIAL SERVICES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598070013
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/13/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 177
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDLAND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22728-0177
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-401-3912
Provider Business Mailing Address Fax Number:
540-439-9634

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5114 CEDAR LANE FARM RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDLAND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-401-3912
Provider Business Practice Location Address Fax Number:
540-439-9634
Provider Enumeration Date:
08/09/2010

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
REARDON
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
703-401-3912

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  2705 098261 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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