Provider Demographics
NPI:1306622840
Name:REACHING YOUR POTENTIALS HOME CARE, LLC
Entity type:Organization
Organization Name:REACHING YOUR POTENTIALS HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:YAKISHA
Authorized Official - Middle Name:CARAVELLE
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:864-567-6046
Mailing Address - Street 1:44 PINE KNOLL DR STE K
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-3257
Mailing Address - Country:US
Mailing Address - Phone:864-991-8856
Mailing Address - Fax:864-991-8893
Practice Address - Street 1:44 PINE KNOLL DR STE K
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-3257
Practice Address - Country:US
Practice Address - Phone:864-991-8856
Practice Address - Fax:864-991-8893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care