Provider Demographics
NPI:1619332947
Name:COMMUNITY OUTREACH LLC
Entity Type:Organization
Organization Name:COMMUNITY OUTREACH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:VERONICA
Authorized Official - Last Name:MARK
Authorized Official - Suffix:
Authorized Official - Credentials:LGSW
Authorized Official - Phone:410-979-5340
Mailing Address - Street 1:3524 LYNNE HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21244-3661
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2300 GARRISON BLVD STE 130
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21216-2316
Practice Address - Country:US
Practice Address - Phone:410-979-5340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-31
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health