Provider Demographics
NPI:1275298127
Name:ALICIA GREGORIOS REYES LLC
Entity type:Organization
Organization Name:ALICIA GREGORIOS REYES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:GREGORIOS
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:843-597-6564
Mailing Address - Street 1:407 W ELDORADO PKWY STE 150
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-5081
Mailing Address - Country:US
Mailing Address - Phone:469-722-4874
Mailing Address - Fax:469-498-5950
Practice Address - Street 1:407 W ELDORADO PKWY STE 150
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-5081
Practice Address - Country:US
Practice Address - Phone:469-722-4874
Practice Address - Fax:469-498-5950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-05
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive Care
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX24395430OtherVA