Provider Demographics
NPI:1508387903
Name:OUTREACH CITY
Entity Type:Organization
Organization Name:OUTREACH CITY
Other - Org Name:OUTREACH CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BENAMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-458-9997
Mailing Address - Street 1:26671 LOGANBERRY DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-1142
Mailing Address - Country:US
Mailing Address - Phone:404-458-9997
Mailing Address - Fax:
Practice Address - Street 1:201 17TH ST NW STE 300
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30363-1191
Practice Address - Country:US
Practice Address - Phone:404-458-9997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-06
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251B00000X, 251S00000X, 252Y00000X, 320800000X
OH251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No252Y00000XAgenciesEarly Intervention Provider Agency
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness