Healthcare Provider Details

I. General information

NPI: 1750837662
Provider Name (Legal Business Name): HARGRAVES OUTREACH INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 04/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6802 PARAGON PL STE 410
RICHMOND VA
23230-1655
US

IV. Provider business mailing address

5020 ROBINWOOD RD
DURHAM NC
27713-1634
US

V. Phone/Fax

Practice location:
  • Phone: 919-358-3730
  • Fax: 844-892-9261
Mailing address:
  • Phone: 919-358-3730
  • Fax: 844-892-9261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. ALAN HARGRAVES
Title or Position: EXECUTIVE DIRECTOR
Credential: CESP, CSAC-I
Phone: 919-358-3730