Provider Demographics
NPI:1750198461
Name:ELEVATING POTENIAL OUTREACH SERVICES
Entity type:Organization
Organization Name:ELEVATING POTENIAL OUTREACH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:HOLBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-532-6983
Mailing Address - Street 1:913 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-5722
Mailing Address - Country:US
Mailing Address - Phone:513-532-6983
Mailing Address - Fax:513-424-6288
Practice Address - Street 1:913 14TH AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-5722
Practice Address - Country:US
Practice Address - Phone:513-532-6983
Practice Address - Fax:513-424-6288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-16
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty
No251V00000XAgenciesVoluntary or CharitableGroup - Single Specialty