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General NPI Number Information
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NPI Number | 1063817088
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Entity Type | Organization
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Legal Business Name | COMMUNITY OUTREACH FAMILY SERVICES LLC
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Dates
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Enumeration Date | 11/03/2014
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Last Update Date | 11/03/2014
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Provider Practice Location Address
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Address Line | 409 S MAIN ST
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City | EMPORIA
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State | VA
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Zip | 23847-2313
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Country | US
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Telephone | 919-561-3111
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Fax | 866-230-4856
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Provider Business Mailing Address
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Address Line | 409 S MAIN ST
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City | EMPORIA
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State | VA
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Zip | 23847-2313
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Country | US
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Telephone | 919-561-3111
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Fax | 866-230-4856
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Authorized Official
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Title or Position | CEO
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Name | MS. JACQUELINE MITCHELL
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Credential |
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Telephone | 919-561-3111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1826
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License Number State | VA
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