Provider Demographics
NPI:1659813335
Name:COMMUNITY OUTREACH YOUTH SERVICES LLC
Entity Type:Organization
Organization Name:COMMUNITY OUTREACH YOUTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ARLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:EMANUEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-827-0111
Mailing Address - Street 1:177 CARDINAL AVE
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28360-9386
Mailing Address - Country:US
Mailing Address - Phone:910-827-0111
Mailing Address - Fax:
Practice Address - Street 1:177 CARDINAL AVE
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28360-9386
Practice Address - Country:US
Practice Address - Phone:910-827-0111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-10
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-078-317320800000X
3245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children