MEDICARE: OUTREACH FAMILY SERVICES LLC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1548641020
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OUTREACH FAMILY SERVICES LLC

Provider Business Mailing Address
First Line	:	PO BOX 101
Second Line	:
City	:	GLOSTER
State	:	LA
Zip	:	71030-0101
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	213 WASHINGTON AVE
Second Line	:
City	:	MANSFIELD
State	:	LA
Zip	:	71052-2605
Country	:	US
Telephone Number	:	318-872-0262
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. SHERATON FULLER
Credential	:
Telephone Number	:	318-540-6441

Provider Enumeration Date	:	06/10/2015
Last Update Date	:	06/10/2015

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