Healthcare Provider Details

I. General information

NPI: 1750198461
Provider Name (Legal Business Name): ELEVATING POTENIAL OUTREACH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 14TH AVE
MIDDLETOWN OH
45044-5722
US

IV. Provider business mailing address

913 14TH AVE
MIDDLETOWN OH
45044-5722
US

V. Phone/Fax

Practice location:
  • Phone: 513-532-6983
  • Fax: 513-424-6288
Mailing address:
  • Phone: 513-532-6983
  • Fax: 513-424-6288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: ANGELA DENISE HOLBROOK
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 513-532-6983