Provider Demographics
NPI:1043653645
Name:OUTREACH SERVICES, LTD
Entity Type:Organization
Organization Name:OUTREACH SERVICES, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEXTER
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-426-6323
Mailing Address - Street 1:318 N ARCH RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23236-3567
Mailing Address - Country:US
Mailing Address - Phone:804-426-6323
Mailing Address - Fax:804-794-6996
Practice Address - Street 1:2306 EDENBROOK DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23228-3010
Practice Address - Country:US
Practice Address - Phone:804-426-6323
Practice Address - Fax:804-794-6996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-12
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VACRF-462320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness