Provider Demographics
NPI:1710415757
Name:COMMUNITY OUTREACH ADVOCATES INCORPORATED
Entity Type:Organization
Organization Name:COMMUNITY OUTREACH ADVOCATES INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:PIERRE
Authorized Official - Last Name:GOUGIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-858-7372
Mailing Address - Street 1:279 MERRILL AVE
Mailing Address - Street 2:
Mailing Address - City:CALUMET CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60409-1716
Mailing Address - Country:US
Mailing Address - Phone:773-209-1968
Mailing Address - Fax:888-858-7372
Practice Address - Street 1:3440 171ST PL
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46323-2807
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-02
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN15-013746-1372600000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty