Provider Demographics
NPI:1467759225
Name:S&M OUTREACH, INC.
Entity Type:Organization
Organization Name:S&M OUTREACH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:R
Authorized Official - Last Name:KIMBER
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:225-928-5842
Mailing Address - Street 1:1738 WOODDALE BLVD
Mailing Address - Street 2:P.O. BOX 64843
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-1507
Mailing Address - Country:US
Mailing Address - Phone:225-928-5842
Mailing Address - Fax:
Practice Address - Street 1:1738 WOODDALE BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-1507
Practice Address - Country:US
Practice Address - Phone:225-928-5842
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-14
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA346251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health