Provider Demographics
NPI:1609374206
Name:COMMUNITY OUTREACH SERVICE CENTER CORP.
Entity Type:Organization
Organization Name:COMMUNITY OUTREACH SERVICE CENTER CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:R
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-913-4680
Mailing Address - Street 1:2165 S IVEY LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-4980
Mailing Address - Country:US
Mailing Address - Phone:407-913-4680
Mailing Address - Fax:407-704-2559
Practice Address - Street 1:3239 OLD WINTER GARDEN RD STE 10
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-1122
Practice Address - Country:US
Practice Address - Phone:407-913-4680
Practice Address - Fax:407-704-2559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)