Provider Demographics
NPI:1407597941
Name:OUTREACH HOME HEALTHCARE
Entity Type:Organization
Organization Name:OUTREACH HOME HEALTHCARE
Other - Org Name:OUTREACH HOME HEALTHCARE & DMES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MILA
Authorized Official - Middle Name:A
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:OPERATOR
Authorized Official - Phone:201-754-2675
Mailing Address - Street 1:PO BOX 168
Mailing Address - Street 2:
Mailing Address - City:COFFEYVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67337-0168
Mailing Address - Country:US
Mailing Address - Phone:201-754-2675
Mailing Address - Fax:
Practice Address - Street 1:107 W 1ST ST
Practice Address - Street 2:
Practice Address - City:COFFEYVILLE
Practice Address - State:KS
Practice Address - Zip Code:67337-5515
Practice Address - Country:US
Practice Address - Phone:201-754-2675
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-06
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health