Provider Demographics
NPI:1043349442
Name:STRATFORD OUTREACH,INC.
Entity Type:Organization
Organization Name:STRATFORD OUTREACH,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMEKA
Authorized Official - Middle Name:MACHAE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:CLINICAL DIRECTOR
Authorized Official - Phone:910-264-5045
Mailing Address - Street 1:PO BOX 12221
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27709-2221
Mailing Address - Country:US
Mailing Address - Phone:910-264-5045
Mailing Address - Fax:718-649-8725
Practice Address - Street 1:3329 WRIGHTSVILLE AVE STE K
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4101
Practice Address - Country:US
Practice Address - Phone:910-264-5045
Practice Address - Fax:910-799-5747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-04
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301746Medicaid