MEDICARE: COMMUNITY OUTREACH SERVICES LLC

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	:	1962974725
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY OUTREACH SERVICES LLC

Provider Business Mailing Address
First Line	:	2133 SILVERSIDE DR STE F
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70808-4179
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2133 SILVERSIDE DR STE F
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70808-4179
Country	:	US
Telephone Number	:	225-250-5677
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ELLIOTT TEMPLE
Credential	:
Telephone Number	:	225-939-1324

Provider Enumeration Date	:	12/18/2018
Last Update Date	:	12/18/2018

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