MEDICARE: OUTREACH SERVICES, LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320800000X	Mental Illness Community Based Residential Treatment Facility	CRF-462	VA

General Provider Information

NPI Number	:	1043653645
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OUTREACH SERVICES, LTD

Provider Business Mailing Address
First Line	:	318 N ARCH RD
Second Line	:	SUITE 201
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23236-3567
Country	:	US
Telephone Number	:	804-426-6323
Fax Number	:	804-794-6996

Provider Business Practice Location Address
First Line	:	2306 EDENBROOK DR
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23228-3010
Country	:	US
Telephone Number	:	804-426-6323
Fax Number	:	804-794-6996

Authorized Official
Title or Position	:	OWNER
Name	:	MR. DEXTER EDWARD WILLIAMS
Credential	:
Telephone Number	:	804-426-6323

Provider Enumeration Date	:	04/12/2013
Last Update Date	:	04/12/2013

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Directions to “OUTREACH SERVICES, LTD ” Practice Location

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