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General NPI Number Information
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NPI Number | 1295770576
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Entity Type | Organization
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Legal Business Name | OUTREACH HEALTHCARE SERVICES
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5409 SHOREVIEW DR
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City | CONCORD
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State | NC
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Zip | 28025-9417
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Country | US
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Telephone | 704-788-7082
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Fax | 866-336-8802
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Provider Business Mailing Address
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Address Line | PO BOX 318
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City | MIDLAND
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State | NC
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Zip | 28107-0318
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Country | US
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Telephone | 704-788-7082
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Fax | 866-336-8802
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | JEAN GRISWOLD LYNN
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Credential |
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Telephone | 704-788-7082
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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