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General NPI Number Information
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NPI Number | 1962794917
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Entity Type | Organization
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Legal Business Name | OUTREACH COMMUNITY CARE NETWORK
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Dates
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Enumeration Date | 05/10/2011
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Last Update Date | 05/10/2011
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Provider Practice Location Address
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Address Line | 240 N FREDERICK AVE
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-3400
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Country | US
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Telephone | 386-255-5569
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Fax |
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Provider Business Mailing Address
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Address Line | 240 N FREDERICK AVE
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-3400
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Country | US
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Telephone | 386-255-5569
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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 | LORETTA JENNINGS
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Credential |
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Telephone | 386-255-5569
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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 | 171M00000X
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License Number State | FL
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