Provider Demographics
NPI:1790268324
Name:A1 COMMUNITY OUTREACH INC
Entity Type:Organization
Organization Name:A1 COMMUNITY OUTREACH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRISEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:813-610-4143
Mailing Address - Street 1:10123 E SLIGH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-9229
Mailing Address - Country:US
Mailing Address - Phone:813-610-4143
Mailing Address - Fax:
Practice Address - Street 1:10123 E SLIGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-9229
Practice Address - Country:US
Practice Address - Phone:813-610-4143
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health