=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417346735
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OUTREACH CARE SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2015
-----------------------------------------------------
Last Update Date | 01/12/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 672 NEW YORK AVE
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43201-2945
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-496-3997
-----------------------------------------------------
Fax | 614-338-8110
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 672 NEW YORK AVE
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43201-2945
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-496-3997
-----------------------------------------------------
Fax | 614-338-8110
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. NAYE DIENG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 614-496-4997
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 2566469
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------