Provider Demographics
NPI:1396513578
Name:RIVER OUTREACH CORPORATION
Entity type:Organization
Organization Name:RIVER OUTREACH CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HOLLIS
Authorized Official - Middle Name:GLEN
Authorized Official - Last Name:KABLER
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:606-584-4420
Mailing Address - Street 1:930 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:MAYSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41056-1495
Mailing Address - Country:US
Mailing Address - Phone:606-375-7673
Mailing Address - Fax:606-407-6006
Practice Address - Street 1:930 FOREST AVE
Practice Address - Street 2:
Practice Address - City:MAYSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41056-1495
Practice Address - Country:US
Practice Address - Phone:606-375-7673
Practice Address - Fax:606-407-6006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health