Provider Demographics
NPI:1164522371
Name:OUTREACH CARE GROUP, INC.
Entity Type:Organization
Organization Name:OUTREACH CARE GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:SKUBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-752-6748
Mailing Address - Street 1:724 PERSHING ST
Mailing Address - Street 2:
Mailing Address - City:ELLWOOD CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16117-1474
Mailing Address - Country:US
Mailing Address - Phone:724-752-0081
Mailing Address - Fax:724-752-0966
Practice Address - Street 1:304 EVANS DR
Practice Address - Street 2:
Practice Address - City:ELLWOOD CITY
Practice Address - State:PA
Practice Address - Zip Code:16117-1477
Practice Address - Country:US
Practice Address - Phone:724-752-1643
Practice Address - Fax:724-752-3405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP415150L332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3971404OtherNABP
PA01574660Medicaid
PA01574660Medicaid