Provider Demographics
NPI:1841580016
Name:OUTREACH YOUTH & FAMILY SERVICES
Entity Type:Organization
Organization Name:OUTREACH YOUTH & FAMILY SERVICES
Other - Org Name:OUTREACH YOUTH SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-840-4497
Mailing Address - Street 1:7041 S HALSTED ST
Mailing Address - Street 2:9443 SO. THROOP
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60621-1713
Mailing Address - Country:US
Mailing Address - Phone:773-840-4497
Mailing Address - Fax:773-905-1369
Practice Address - Street 1:7041 S HALSTED ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-1713
Practice Address - Country:US
Practice Address - Phone:773-840-4497
Practice Address - Fax:773-905-1369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL60716579251B00000X, 251C00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No252Y00000XAgenciesEarly Intervention Provider Agency