Provider Demographics
NPI:1073161881
Name:OUTLETS FOR HOPE, INC
Entity Type:Organization
Organization Name:OUTLETS FOR HOPE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:
Authorized Official - Last Name:IGWEOBI
Authorized Official - Suffix:
Authorized Official - Credentials:MS,BSN,RN
Authorized Official - Phone:508-340-1657
Mailing Address - Street 1:4 MAIN ST STE G2
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-4027
Mailing Address - Country:US
Mailing Address - Phone:508-840-1657
Mailing Address - Fax:888-340-8272
Practice Address - Street 1:4 MAIN ST STE G2
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4027
Practice Address - Country:US
Practice Address - Phone:508-840-1657
Practice Address - Fax:888-340-8272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251V00000XAgenciesVoluntary or Charitable
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility