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General NPI Number Information
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NPI Number | 1811718471
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Entity Type | Organization
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Legal Business Name | OUTREACH ADVOCACY CENTER INC.
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Dates
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Enumeration Date | 10/17/2024
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 2300 FERRY ST STE B
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City | LAFAYETTE
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State | IN
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Zip | 47904-3060
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Country | US
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Telephone | 765-237-8894
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Fax |
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Provider Business Mailing Address
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Address Line | 2300 FERRY ST STE B
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City | LAFAYETTE
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State | IN
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Zip | 47904-3060
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Country | US
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Telephone | 765-237-8894
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | PAIGE LOGAN
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Credential |
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Telephone | 765-237-8894
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2083A0300X
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Taxonomy Name | Addiction Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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Taxonomy #5
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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 |
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Taxonomy #6
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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