Provider Demographics
NPI:1255654018
Name:OUTREACH HEALTH CARE LLC
Entity Type:Organization
Organization Name:OUTREACH HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LUANNE
Authorized Official - Middle Name:CASTILLO
Authorized Official - Last Name:BARBERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-808-1039
Mailing Address - Street 1:7863 BROADWAY
Mailing Address - Street 2:SUITE 126
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-5553
Mailing Address - Country:US
Mailing Address - Phone:219-769-6650
Mailing Address - Fax:219-769-6852
Practice Address - Street 1:7863 BROADWAY
Practice Address - Street 2:SUITE 126
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5553
Practice Address - Country:US
Practice Address - Phone:219-769-6650
Practice Address - Fax:219-769-6852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN15D2002865OtherCLIA#