Provider Demographics
NPI:1417346735
Name:OUTREACH CARE SERVICES
Entity Type:Organization
Organization Name:OUTREACH CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NAYE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIENG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-496-4997
Mailing Address - Street 1:672 NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-2945
Mailing Address - Country:US
Mailing Address - Phone:614-496-3997
Mailing Address - Fax:614-338-8110
Practice Address - Street 1:672 NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201-2945
Practice Address - Country:US
Practice Address - Phone:614-496-3997
Practice Address - Fax:614-338-8110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2566469251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0104848Medicaid