Provider Demographics
NPI:1417080680
Name:OUTREACH MANAGEMENT SERVICES LLC
Entity Type:Organization
Organization Name:OUTREACH MANAGEMENT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:XAVIER
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:QP
Authorized Official - Phone:704-854-9828
Mailing Address - Street 1:1723 ARMSTRONG PARK DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-4802
Mailing Address - Country:US
Mailing Address - Phone:704-854-9828
Mailing Address - Fax:704-854-9882
Practice Address - Street 1:1723 ARMSTRONG PARK DR
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-4802
Practice Address - Country:US
Practice Address - Phone:704-854-9828
Practice Address - Fax:704-854-9882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-036-235251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300696DMedicaid
NC8300696Medicaid
NC8300696GMedicaid
NC8300696HMedicaid
NC8300696QMedicaid
NC6005781Medicaid
NC8300696BMedicaid