Provider Demographics
NPI:1689878639
Name:COMMUNITY OUTREACH SERVICES
Entity Type:Organization
Organization Name:COMMUNITY OUTREACH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTEMIN EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:EPLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-736-0420
Mailing Address - Street 1:245 S AMELIA AVE
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-5913
Mailing Address - Country:US
Mailing Address - Phone:386-736-0420
Mailing Address - Fax:386-738-4838
Practice Address - Street 1:245 S AMELIA AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-5913
Practice Address - Country:US
Practice Address - Phone:386-736-0420
Practice Address - Fax:386-738-4838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1264AD8975-00324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility