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General NPI Number Information
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NPI Number | 1689878639
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Entity Type | Organization
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Legal Business Name | COMMUNITY OUTREACH SERVICES
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Dates
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Enumeration Date | 06/13/2007
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Last Update Date | 06/06/2008
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Provider Practice Location Address
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Address Line | 245 S AMELIA AVE
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City | DELAND
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State | FL
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Zip | 32724-5913
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Country | US
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Telephone | 386-736-0420
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Fax | 386-738-4838
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Provider Business Mailing Address
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Address Line | 245 S AMELIA AVE
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City | DELAND
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State | FL
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Zip | 32724-5913
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Country | US
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Telephone | 386-736-0420
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Fax | 386-738-4838
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Authorized Official
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Title or Position | INTEMIN EXECUTIVE DIRECTOR
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Name | MR. CARL EPLEY
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Credential |
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Telephone | 386-736-0420
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 1264AD8975-00
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License Number State | FL
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