Provider Demographics
NPI:1316539745
Name:COMMUNITY IMPROVEMENT HEALTH OUTREACH
Entity Type:Organization
Organization Name:COMMUNITY IMPROVEMENT HEALTH OUTREACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAB DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TOMICKA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MCMILLION
Authorized Official - Suffix:
Authorized Official - Credentials:RN,DNP
Authorized Official - Phone:862-287-5410
Mailing Address - Street 1:12 MONTCLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07503-2418
Mailing Address - Country:US
Mailing Address - Phone:862-287-5410
Mailing Address - Fax:
Practice Address - Street 1:12 MONTCLAIR AVE
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07503-2418
Practice Address - Country:US
Practice Address - Phone:862-287-5410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory