Provider Demographics
NPI:1477880458
Name:OUTREACH MRDD SERVICES
Entity Type:Organization
Organization Name:OUTREACH MRDD SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIRADA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MORELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-380-1572
Mailing Address - Street 1:28075 LOGAN HORNSMILL RD
Mailing Address - Street 2:
Mailing Address - City:SUGAR GROVE
Mailing Address - State:OH
Mailing Address - Zip Code:43155-9613
Mailing Address - Country:US
Mailing Address - Phone:740-380-1572
Mailing Address - Fax:
Practice Address - Street 1:28075 LOGAN HORNSMILL RD
Practice Address - Street 2:
Practice Address - City:SUGAR GROVE
Practice Address - State:OH
Practice Address - Zip Code:43155-9613
Practice Address - Country:US
Practice Address - Phone:740-380-1572
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty