MEDICARE: GREATER OUTREACH SERVICES, LLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427288919
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREATER OUTREACH SERVICES, LLP

Provider Business Mailing Address
First Line	:	2530 MERIDIAN PKWY STE 3006
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27713-5272
Country	:	US
Telephone Number	:	833-741-7770
Fax Number	:	866-770-5166

Provider Business Practice Location Address
First Line	:	2530 MERIDIAN PKWY STE 3006
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27713-5272
Country	:	US
Telephone Number	:	833-741-7770
Fax Number	:	866-770-5166

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MISS NYESHA SHANTA ROBINSON
Credential	:	MSAC
Telephone Number	:	919-672-2407

Provider Enumeration Date	:	07/20/2009
Last Update Date	:	11/03/2021

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