Provider Demographics
NPI:1295770576
Name:OUTREACH HEALTHCARE SERVICES
Entity type:Organization
Organization Name:OUTREACH HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:GRISWOLD
Authorized Official - Last Name:LYNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-788-7082
Mailing Address - Street 1:PO BOX 318
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28107-0318
Mailing Address - Country:US
Mailing Address - Phone:704-788-7082
Mailing Address - Fax:866-336-8802
Practice Address - Street 1:5409 SHOREVIEW DR
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-9417
Practice Address - Country:US
Practice Address - Phone:704-788-7082
Practice Address - Fax:866-336-8802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2881777Medicare ID - Type Unspecified