Provider Demographics
NPI:1750837662
Name:HARGRAVES OUTREACH INC.
Entity Type:Organization
Organization Name:HARGRAVES OUTREACH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARGRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:CESP, CSAC-I
Authorized Official - Phone:919-358-3730
Mailing Address - Street 1:5020 ROBINWOOD RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-1634
Mailing Address - Country:US
Mailing Address - Phone:919-358-3730
Mailing Address - Fax:844-892-9261
Practice Address - Street 1:6802 PARAGON PL STE 410
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-1655
Practice Address - Country:US
Practice Address - Phone:919-358-3730
Practice Address - Fax:844-892-9261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251V00000XAgenciesVoluntary or Charitable
No347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1750837662Medicaid