Provider Demographics
NPI:1265067425
Name:MOBILE OUTREACH ALLIANCE
Entity type:Organization
Organization Name:MOBILE OUTREACH ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:ROMANOVNA
Authorized Official - Last Name:KOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-506-4698
Mailing Address - Street 1:8422 W 78TH CIR
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80005-4407
Mailing Address - Country:US
Mailing Address - Phone:303-506-4698
Mailing Address - Fax:
Practice Address - Street 1:8422 W 78TH CIR
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80005-4407
Practice Address - Country:US
Practice Address - Phone:303-506-4698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
No1223D0001XDental ProvidersDentistDental Public HealthGroup - Multi-Specialty
No251K00000XAgenciesPublic Health or WelfareGroup - Multi-Specialty