MEDICARE: DNL OUTREACH 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	DSS	VA

General Provider Information

NPI Number	:	1184814543
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DNL OUTREACH LTD

Provider Business Mailing Address
First Line	:	PO BOX 35201
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23235-0201
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	:	LAVERA WILLIAMS
Credential	:
Telephone Number	:	804-426-6323

Provider Enumeration Date	:	07/31/2007
Last Update Date	:	07/31/2007

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Directions to “DNL OUTREACH LTD ” Practice Location

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