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General NPI Number Information
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NPI Number | 1417080680
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Entity Type | Organization
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Legal Business Name | OUTREACH MANAGEMENT SERVICES LLC
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 02/17/2010
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Provider Practice Location Address
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Address Line | 1723 ARMSTRONG PARK DR
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City | GASTONIA
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State | NC
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Zip | 28054-4802
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Country | US
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Telephone | 704-854-9828
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Fax | 704-854-9882
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Provider Business Mailing Address
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Address Line | 1723 ARMSTRONG PARK DR
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City | GASTONIA
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State | NC
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Zip | 28054-4802
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Country | US
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Telephone | 704-854-9828
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Fax | 704-854-9882
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. ALEXANDER XAVIER WALKER
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Credential | QP
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Telephone | 704-854-9828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | MHL-036-235
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MHL-036-235
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License Number State | NC
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