Provider Demographics
NPI:1235272469
Name:DELIVERANCE OUTREACH
Entity Type:Organization
Organization Name:DELIVERANCE OUTREACH
Other - Org Name:RESTORED HOPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:M
Authorized Official - Last Name:COWAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-225-6520
Mailing Address - Street 1:65 WALTON ST
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4716
Mailing Address - Country:US
Mailing Address - Phone:828-225-6520
Mailing Address - Fax:828-225-3762
Practice Address - Street 1:41 IMPERIAL CT
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-1812
Practice Address - Country:US
Practice Address - Phone:828-225-6520
Practice Address - Fax:828-225-3762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL011253322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6603855Medicaid