Provider Demographics
NPI:1700579943
Name:DIVERSITY OUTREACH SERVICES, LLC
Entity Type:Organization
Organization Name:DIVERSITY OUTREACH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER - MANAGER- PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:QUINN
Authorized Official - Last Name:CORRIVEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-401-8489
Mailing Address - Street 1:122 FOLLY MILL RD UNIT B
Mailing Address - Street 2:
Mailing Address - City:SEABROOK
Mailing Address - State:NH
Mailing Address - Zip Code:03874-4016
Mailing Address - Country:US
Mailing Address - Phone:603-401-8489
Mailing Address - Fax:
Practice Address - Street 1:122 FOLLY MILL RD UNIT B
Practice Address - Street 2:
Practice Address - City:SEABROOK
Practice Address - State:NH
Practice Address - Zip Code:03874-4016
Practice Address - Country:US
Practice Address - Phone:603-401-8489
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-01
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251X00000XAgenciesSupports Brokerage