Healthcare Provider Details

I. General information

NPI: 1841580016
Provider Name (Legal Business Name): OUTREACH YOUTH & FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2011
Last Update Date: 04/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7041 S HALSTED ST
CHICAGO IL
60621-1713
US

IV. Provider business mailing address

7041 S HALSTED ST 9443 SO. THROOP
CHICAGO IL
60621-1713
US

V. Phone/Fax

Practice location:
  • Phone: 773-840-4497
  • Fax: 773-905-1369
Mailing address:
  • Phone: 773-840-4497
  • Fax: 773-905-1369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number60716579
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number60716579
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number60716579
License Number StateIL

VIII. Authorized Official

Name: MR. EDDIE J PHILLIPS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 773-840-4497