Provider Demographics
NPI:1063817088
Name:COMMUNITY OUTREACH FAMILY SERVICES LLC
Entity Type:Organization
Organization Name:COMMUNITY OUTREACH FAMILY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-561-3111
Mailing Address - Street 1:409 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:VA
Mailing Address - Zip Code:23847-2313
Mailing Address - Country:US
Mailing Address - Phone:919-561-3111
Mailing Address - Fax:866-230-4856
Practice Address - Street 1:409 S MAIN ST
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:VA
Practice Address - Zip Code:23847-2313
Practice Address - Country:US
Practice Address - Phone:919-561-3111
Practice Address - Fax:866-230-4856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-03
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1826251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health