Healthcare Provider Details

I. General information

NPI: 1043653645
Provider Name (Legal Business Name): OUTREACH SERVICES, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2013
Last Update Date: 04/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2306 EDENBROOK DR
RICHMOND VA
23228-3010
US

IV. Provider business mailing address

318 N ARCH RD SUITE 201
NORTH CHESTERFIELD VA
23236-3567
US

V. Phone/Fax

Practice location:
  • Phone: 804-426-6323
  • Fax: 804-794-6996
Mailing address:
  • Phone: 804-426-6323
  • Fax: 804-794-6996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberCRF-462
License Number StateVA

VIII. Authorized Official

Name: MR. DEXTER EDWARD WILLIAMS
Title or Position: OWNER
Credential:
Phone: 804-426-6323