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General NPI Number Information
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NPI Number | 1699733600
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Entity Type | Organization
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Legal Business Name | OUTREACH COMMUNITY LIVING SERVICES INC.
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Dates
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Enumeration Date | 05/02/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 337 W NORTH ST
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City | WOOSTER
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State | OH
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Zip | 44691-4821
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Country | US
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Telephone | 330-263-0862
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Fax | 330-262-8423
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Provider Business Mailing Address
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Address Line | 337 W NORTH ST
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City | WOOSTER
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State | OH
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Zip | 44691-4821
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Country | US
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Telephone | 330-263-0862
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Fax | 330-262-8423
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. J PENELOPE KIDDER
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Credential | MA, LPCC
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Telephone | 330-263-0862
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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 | 0184
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License Number State | OH
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