Provider Demographics
NPI:1811690944
Name:INNER REACHES HEALING ARTS, LLC
Entity type:Organization
Organization Name:INNER REACHES HEALING ARTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BORGLUM
Authorized Official - Suffix:
Authorized Official - Credentials:LCAT
Authorized Official - Phone:716-785-4725
Mailing Address - Street 1:PO BOX 93
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14544-0093
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4730 FERGUSON CORNERS RD
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:NY
Practice Address - Zip Code:14544-9623
Practice Address - Country:US
Practice Address - Phone:716-785-4725
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty