Provider Demographics
NPI:1437330560
Name:OUTREACH RESIDENTIAL SERVICES
Entity Type:Organization
Organization Name:OUTREACH RESIDENTIAL SERVICES
Other - Org Name:OUTREACH RESIDENTIAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-423-1855
Mailing Address - Street 1:5304 HUB JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-7820
Mailing Address - Country:US
Mailing Address - Phone:910-423-1855
Mailing Address - Fax:
Practice Address - Street 1:3520 MAXWELL RD
Practice Address - Street 2:
Practice Address - City:AUTRYVILLE
Practice Address - State:NC
Practice Address - Zip Code:28318-8785
Practice Address - Country:US
Practice Address - Phone:910-423-1855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-082-069322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children