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General NPI Number Information
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NPI Number | 1508387903
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Entity Type | Organization
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Legal Business Name | OUTREACH CITY
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Dates
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Enumeration Date | 07/06/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 201 17TH ST NW STE 300
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City | ATLANTA
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State | GA
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Zip | 30363-1191
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Country | US
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Telephone | 404-458-9997
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Fax |
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Provider Business Mailing Address
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Address Line | 26671 LOGANBERRY DR
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City | RICHMOND HEIGHTS
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State | OH
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Zip | 44143-1142
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Country | US
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Telephone | 404-458-9997
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | AUSTIN BENAMON
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Credential |
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Telephone | 404-458-9997
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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 |
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State | GA
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Taxonomy #5
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State | GA
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Taxonomy #6
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | GA
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