Provider Demographics
NPI:1598934648
Name:LIFE AND HOPE OUTREACH CENTER
Entity Type:Organization
Organization Name:LIFE AND HOPE OUTREACH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-733-0101
Mailing Address - Street 1:2520 E BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-3559
Mailing Address - Country:US
Mailing Address - Phone:870-733-0101
Mailing Address - Fax:870-733-0107
Practice Address - Street 1:2520 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-3559
Practice Address - Country:US
Practice Address - Phone:870-733-0101
Practice Address - Fax:870-733-0107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health